ACC, AHA express concern with conflicting blood pressure measure sets

The American College of Cardiology (ACC) and American Heart Association (AHA) were mostly in agreement with initial core quality measure sets released on Feb. 16 by the Centers for Medicare and Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP).

However, the ACC and AHA noted they “strongly disagree” with two conflicting measure sets for blood pressure control in patients with hypertension and said they have the “potential to harm millions of patients.”

ACC president-elect Richard A. Chazal, MD, and AHA president Mark A. Creager, MD, wrote about the issue in an editorial that was published online in the Journal of the American College of Cardiology and Hypertension on Feb. 16.

They noted one measure defined adequate blood pressure control as less than 140/90 mmHg, while another measure (known as HEDIS 2016) defined adequate blood pressure control as less than 150/90 mmHg for patients who were 60 or older and did not have diabetes or chronic kidney disease.

Although the ACC and AHA participated in the CMA/AHIP Core Quality Measures Collaborative, Chazal and Creager said that the HEDIS 2016 measure was not sanctioned by the National Heart, Lung, and Blood Institute and was not endorsed by AHA and ACC. They added that the measure was incorrectly described as the JNC 8 guideline. They also noted that modeling studies have strongly suggested that a target of 150/90 mm Hg would increase the number of preventable strokes.

“Though we recognize that the inclusion of these two measures was a compromise agreed to by the members of the Collaborative in order to achieve a consensus, AHA and ACC have concerns with the inclusion of the HEDIS 2016 measure in these core measure sets because of its likelihood to increase the number of inadequately treated patients with high [blood pressure], who would then be at greater risk for heart disease and stroke,” Chazal and Creager wrote. “It would be inconsistent with the missions of both ACC and AHA, which are focused on transforming cardiovascular care and helping build healthier lives free of cardiovascular diseases and stroke, if we did not alert patients and the medical community to this risk.”

Chazal and Creager noted that the ACC and AHA are developing guidelines for treating high blood pressure and will likely release them by the end of 2016. They plan on taking into account the results of the landmark SPRINT (Systolic Blood Pressure Intervention Trial) study that was released in November.

In the SPRINT study, adults who were randomized to a target systolic blood pressure of 120 mm Hg had a 25 percent lower relative risk of the primary composite outcome of MI, other acute coronary syndromes, stroke, heart failure or death from cardiovascular causes, 38 percent lower relative risk of heart failure, 43 percent lower relative risk of death from cardiovascular causes and 27 percent lower relative lower risk of death from any cause compared with those who had a target of 140 mm Hg.

“Until the new guideline is published, we urge, as we did in an advisory along with the Centers for Disease Control and Prevention in 2014, all health care providers and patients to strive to reach a BP target of less than 140/90 mmHg,” Chazal and Creager wrote. “To do otherwise puts patients’ lives and well-being at risk. We also urge all patients to talk to their doctors about their own risk for cardiovascular disease and stroke and to learn what steps they can take to reduce it.”