Clinical Edge

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Potential US Population Impact of New BP Guideline

Circulation; ePub 2017 Nov 13; Muntner, et al

The newly-released 2017 American College of Cardiology/American Heart Association (ACC/AHA) high blood pressure (BP) guideline results in a substantial increase in the prevalence of hypertension when compared with the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) guideline, but a small increase in the percentage of US adults recommended antihypertensive medications, according to a recent analysis. Moreover, a substantial proportion of US adults taking antihypertensive medication are recommended to have more intensive BP lowering under the guideline. Further details include:

  • The overall crude prevalence among US adults according to the 2017 ACC/AHA and JNC7 guidelines, was 45.6% and 31.9%; antihypertensive medications was recommended for 36.2% and 34.3%, respectively.
  • Compared to US adults for whom antihypertensive medication was recommended by JNC7, those recommended treatment by the 2017 ACC/AHA guideline but not JNC7 had higher CVD risk.
  • Among US adults taking antihypertensive medication, 53.4% and 39.0% had BP above the treatment goal according to the 2017 ACC/AHA and JNC7 guidelines, respectively.
  • Overall, 103.3 million US adults had hypertension according the 2017 ACC/AHA guideline, of whom 81.9 million were recommended to receive antihypertensive medication.

Citation:

Muntner P, Carey RM, Gidding S, et al. Potential US population impact of the 2017 American College of Cardiology/American Heart Association high blood pressure guideline. [Published online ahead of print November 13, 2017]. Circulation. doi:10.1161/CIRCULATIONAHA.117.032582.

Commentary:

The new hypertension guideline substantially increases the number of people who will be diagnosed with hypertension. This is especially true for males aged 20-45 years in whom the prevalence of hypertension will increase from approximately 10% to 30% of the population. The recommendation for the majority of patients in this cohort is intensive lifestyle modification, which, when done correctly, can decrease blood pressure by 5-20 mm Hg. Of people who have hypertension and are currently receiving medications, the new recommendations substantially increase the number of people who are not treated to goal. Those individuals will need more medications than previously to achieve target blood pressures. —Neil Skolnik, MD

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