Reducing the Blood Pressure-Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control.
BACKGROUND
US blood pressure reduction policies are largely restricted to hypertensive populations and associated benefits are often estimated based on unrealistic interventions.


RESULTS
We used multivariable linear regression to estimate incidence rate differences contrasting the impact of 2 pragmatic hypothetical interventions to reduce coronary heart disease, stroke, and heart failure (HF) incidence: (1) a population-wide intervention that reduced systolic blood pressure by 1 mm Hg and (2) targeted interventions that reduced the prevalence of unaware, untreated, or uncontrolled blood pressure above goal (per Eighth Joint National Committee treatment thresholds) by 10%. In the Atherosclerosis Risk in Communities Study (n=15 744; 45 to 64 years at baseline, 1987-1989), incident coronary heart disease and stroke were adjudicated by physician panels. Incident HF was defined as the first hospitalization with discharge diagnosis code of "428." A 10% proportional reduction in unaware, untreated, or uncontrolled blood pressure above goal resulted in ≈4.61, 3.55, and 11.01 fewer HF events per 100,000 person-years in African Americans, and 3.77, 1.63, and 4.44 fewer HF events per 100 000 person-years, respectively, in whites. In contrast, a 1 mm Hg population-wide systolic blood pressure reduction was associated with 20.3 and 13.3 fewer HF events per 100 000 person-years in African Americans and whites, respectively. Estimated event reductions for coronary heart disease and stroke were smaller than for HF, but followed a similar pattern for both population-wide and targeted interventions.


CONCLUSIONS
Modest population-wide shifts in systolic blood pressure could have a substantial impact on cardiovascular disease incidence and should be developed in parallel with interventions targeting populations with blood pressure above goal.
Department of Epidemiology, University of North Carolina, Chapel Hill, NC (S.T.H., L.R.L., P.P.C., G.H., C.L.A.).
Shakia T
ST
Hardy
Department of Epidemiology, University of North Carolina, Chapel Hill, NC (S.T.H., L.R.L., P.P.C., G.H., C.L.A.).
Laura R
LR
Loehr
Department of Medicine, University of Mississippi Medical Center, Jackson, MS (K.R.B.).
Kenneth R
KR
Butler
Department of Biostatistics, University of North Carolina, Chapel Hill, NC (S.C.).
Sujatro
S
Chakladar
Department of Epidemiology, University of North Carolina, Chapel Hill, NC (S.T.H., L.R.L., P.P.C., G.H., C.L.A.) Department of Medicine, University of North Carolina, Chapel Hill, NC (P.P.C.).
Patricia P
PP
Chang
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MSMN (A.R.F., R.F.M.L.).
Aaron R
AR
Folsom
Department of Epidemiology, University of North Carolina, Chapel Hill, NC (S.T.H., L.R.L., P.P.C., G.H., C.L.A.).
Gerardo
G
Heiss
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MSMN (A.R.F., R.F.M.L.).
Richard F
RF
MacLehose
Department of Epidemiology, Johns Hopkins University, Baltimore, MD (K.M.).
Kunihiro
K
Matsushita
Department of Epidemiology, University of North Carolina, Chapel Hill, NC (S.T.H., L.R.L., P.P.C., G.H., C.L.A.).
Christy L
CL
Avery
D001741:Black or African American; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003327:Coronary Disease / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011314:Preventive Health Services / Q000379:methods*; D011446:Prospective Studies; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People
D000959:Antihypertensive Agents
blood pressure; coronary heart disease; epidemiology; heart failure; stroke