SOPH alum, Gabriel Tajeu, DrPh, MPH, rethinking the risk of cardiovascular disease

School of Public Health

In recent decades, the medical community has learned to better manage high blood pressure (HBP), the top risk factor for strokes and heart attacks, resulting in fewer people diagnosed with HBP. Still, many who technically had low blood pressure maintained an elevated risk for cardiovascular disease (CVD), high cholesterol and diabetes.

That’s why researchers began rethinking how we approach the disease. New research from Gabriel S. Tajeu, DrPH, MPH, Temple University College of Public Health assistant professor of health services administration and policy, builds on previous landmark studies such as the Heart Outcomes Prevention Evaluation-3 trial (HOPE-3) and the Systolic Blood Pressure Intervention Trial (SPRINT) that pushed for re-evaluation of the way we detect and treat CVD. Thanks to this body of evidence, the American Heart Association lowered the threshold for HBP classification in November 2017.

Tajeu and a team of researchers surveyed more than 31,000 people who were recruited in the early- to mid-2000s for large cohort studies and who hadn’t had any CVD events such as heart attack or stroke. They obtained baseline demographic and clinical information from the cohorts and measured participants’ blood pressure over an average of 7.5 years.

The results, published in Circulation, pointed to the insufficiency of the former guidelines. Of those who experienced CVD events during the study, more than 60 percent had blood pressure under the former guidelines of 140/90. They also assessed the subjects’ 10-year CVD risk: More than 50 percent of the subjects with blood pressure under 140/90 had a 10-year CVD risk higher than 7.5 percent—a threshold at which doctors should address CVD risk factors through medication or lifestyle changes—but only a little more than a third of them were taking antihypertensive medication.

These results were part of a growing body of evidence that treatment of hypertension may need to occur at blood pressure thresholds lower than 140/90. Tajeu also asserted that using a 10-year risk assessment for CVD may be more beneficial than looking almost exclusively at blood pressure. That means calculating a patient’s cholesterol levels and factoring in whether he or she smokes or has diabetes, for instance, to predict whether the patient has more than a 7.5 percent chance of having a heart attack or stroke in the next 10 years.

“We’re doing a good job managing hypertension in the U.S., but there is still room for improvement,” said Tajeu. “We need to continue our efforts and now potentially get a little more sophisticated to determine who should be treated for chronic diseases that increase cardiovascular disease risk.”

Article courtesy of Temple University College of Public Health

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