Impact of 2017 ACC/AHA High Blood Pressure Guideline

Study Questions:

What is the prevalence of blood pressure (BP) above the treatment goal among US adults, using criteria from the 2017 American College of Cardiology/American Heart Association (ACC/AHA) BP guideline and the Seventh Report of the Joint National Committee (JNC7)?

Methods:

The study investigators analyzed data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) (n = 9,623). NHANES participants completed study interviews and an examination. For each participant, BP was measured three times following a standardized protocol and averaged. Results were weighted to produce US population estimates.

Results:

According to the 2017 ACC/AHA and JNC7 guidelines, the crude prevalence of hypertension among US adults was 45.6% (95% confidence interval [CI], 43.6%-47.6%) and 31.9% (95% CI, 30.1%-33.7%), respectively, and antihypertensive medication was recommended for 36.2% (95% CI, 34.2%-38.2%) and 34.3% (95% CI, 32.5%-36.2%) of US adults, respectively. Nonpharmacological intervention is advised for the 9.4% of US adults with hypertension who are not recommended for antihypertensive medication, according to the 2017 ACC/AHA guideline. Among US adults taking antihypertensive medication, 53.4% (95% CI, 49.9%-56.8%) and 39.0% (95% CI, 36.4%-41.6%) had BP above the treatment goal according to the 2017 ACC/AHA and JNC7 guidelines, respectively.

Conclusions:

The authors concluded that compared with the JNC7 guideline, the 2017 ACC/AHA guideline results in a substantial increase in the prevalence of hypertension, a small increase in the percentage of US adults recommended for antihypertensive medication, and more intensive BP lowering for many adults taking antihypertensive medication.

Perspective:

This study reports that the 2017 ACC/AHA hypertension guideline will result in a substantial increase in the proportion of US adults defined as having hypertension. However, the percentage of US adults recommended for antihypertensive medication increased only modestly, with nonpharmacological interventions alone being recommended for the majority with hypertension according to the 2017 ACC/AHA guideline, but not the JNC7 guideline. The 2017 ACC/AHA hypertension guideline has the potential to increase hypertension awareness, encourage lifestyle modification, and focus on antihypertensive medication initiation, which should translate into a reduction in cardiovascular disease events. This needs to be confirmed in future outcome studies.

Clinical Topics: Prevention, Hypertension

Keywords: Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Hypertension, Life Style, Outcome Assessment (Health Care), Prevalence, Primary Prevention, Treatment Outcome


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