Abstract 281: Antihypertensive Pharmacotherapy Eligibility Based Upon the 2017 ACC/AHA High Blood Pressure Clinical Practice Guidelines Among Young Adults Prior to Myocardial Infarction

Introduction: A recent study showed that in a cohort of young adults with MI (age ≤ 50 years) most young adults would not have been eligible for primary prevention statin therapy prior to their myocardial infarction (MI). Recent guidelines for hypertension re-define stage 1 hypertension to a systolic blood pressure (SBP) 130-139 mmHg or diastolic blood pressure (DBP) 80-89 mmHg and reclassify individuals with stage I hypertension and an elevated risk of atherosclerotic cardiovascular disease (ASCVD) to be eligible for pharmacotherapy. Our aim was to estimate the proportion of individuals with stage 1 hypertension who would be eligible for pharmacotherapy based on the 2017 hypertension guidelines among a cohort of adults ≤ 50 years of age prior to their MI. Methods: The YOUNG-MI registry is a retrospective cohort which includes patients who presented with a first MI at age ≤ 50 to two large academic centers. We simulated the eligibility for anti-hypertensive pharmacotherapy for each patient by assigning a SBP value ranging from 128mmHg to 140 mmHg in 2 mmHg increments, while assuming a normal DBP. All individuals diagnosed with diabetes or chronic kidney disease were considered to be eligible for anti-hypertensive pharmacotherapy if their SBP was greater than or equal to 130mmHg, per the guidelines. The pooled cohort equations were used to calculate the cardiovascular risk in the remaining patients. Those with an ASCVD of ≥ 10% and Stage 1 hypertension (SBP 130-139 mmHg) were considered to be eligible for pharmacotherapy. Results: Among 1838 adults, 284 (15.5%) had diabetes and 142 (9.2%) had chronic kidney disease and were thus classified as eligible for pharmacotherapy. The remaining 1412 individuals (median age 45 years, interquartile range 41-48 years; 17.1% women) had their eligibility determined based on the ASCVD risk score. In this group, the proportion eligible for anti-hypertensive therapy ranged from 7.7% (95% confidence interval 6.5%-9%) for a SBP of 130 to 11.4% (95% CI 9.8%-12.9%) for a SBP of 138 (Figure) . Conclusions: While the new guidelines increase the number of individuals eligible for anti-hypertensive therapy, most young adults with Stage 1 hypertension would still not be eligible for pharmacotherapy prior to their MI, highlighting potential under-treatment of this at-risk young population.