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Proportion of US Adults Potentially Affected by the 2014 Hypertension Guideline
Study Questions:
What is the proportion of US adults potentially affected by recent changes outlined in the 2014 blood pressure (BP) guideline released by the panel members appointed to the Eighth Joint National Committee (JNC 8; 2014 BP guideline)?
Methods:
This was a cross-sectional, nationally representative survey using data from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2010. NHANES data were used to estimate the number of adults who would meet the guideline-based BP targets using the new 2014 BP guidelines. This proportion was then compared to the number of adults who would meet guideline-based targets under the prior seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guideline.
Results:
A total of 16,372 adults from NHANES were included. The proportion of younger adults (ages 18-59 years) with treatment-eligible hypertension (HTN) under the JNC 7 guideline was 20.3% (95% confidence interval [CI], 19.1%-21.4%). This proportion decreased to 19.2% (95% CI, 18.1%-20.4%) under the new 2014 BP guideline. The numbers of older adults (ages ≥60 years) with treatment-eligible HTN decreased from 68.9% (95% CI, 66.9%-70.8%) under JNC 7 to 61.2% (95% CI, 59.3%-63.0%) under the new 2014 BP guideline. The proportion of adults with treatment-eligible HTN who met BP goals increased slightly for younger adults, from 41.2% (95% CI, 38.1%-44.3%) under JNC 7 to 47.5% (95% CI, 44.4%-50.6%) under the 2014 BP guideline, and more substantially for older adults, from 40.0% (95% CI, 37.8%-42.3%) under JNC 7 to 65.8% (95% CI, 63.7%-67.9%) under the 2014 BP guideline. Overall, 1.6% (95% CI, 1.3%-1.9%) of US adults ages 18-59 years and 27.6% (95% CI, 25.9%-29.3%) of adults ages 60 years or older were receiving BP-lowering medication and meeting more stringent JNC 7 targets. These patients may be eligible for less stringent or no BP therapy with the 2014 BP guideline.
Conclusions:
The authors concluded that compared with the JNC 7 guideline, the 2014 BP guideline was associated with a reduction in the proportion of US adults recommended for HTN treatment and a substantial increase in the proportion of adults considered to have achieved goal BP, primarily in older adults.
Perspective:
As expected from the changes between JNC 7 and the new 2014 guideline, more US adults are considered as having controlled HTN and fewer adults will be considered for therapy. The impact of these changes, particularly as they relate to cardiovascular outcomes such as acute coronary syndrome events and strokes, remains to be determined.
Keywords: Acute Coronary Syndrome, Stroke, Cross-Sectional Studies, Confidence Intervals, Blood Pressure Determination, Nutrition Surveys, Hypertension, ACC Annual Scientific Session
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