A Comparison of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline and the 2017 American Diabetes Association Diabetes and Hypertension Position Statement for U.S. Adults With Diabetes

Abstract

Objective: To determine the concordance in the prevalence of hypertension and pharmacological antihypertensive treatment recommendations for U.S. adults with diabetes using definitions from the 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline and the 2017 American Diabetes Association (ADA) diabetes and hypertension position statement.

Research design and methods: We analyzed data for U.S. adults with diabetes in the U.S. National Health and Nutrition Examination Survey (NHANES), 2011-2016 (n = 2,266). Diabetes was defined by treatment with glucose-lowering medication, glycosylated hemoglobin ≥6.5%, fasting serum glucose ≥126 mg/dL, or nonfasting serum glucose ≥200 mg/dL. BP was measured three times and antihypertensive medication use was self-reported.

Results: The prevalence (95% CI) of hypertension among U.S. adults with diabetes was 77.1% (73.9, 80.0) and 66.3% (63.4, 69.1) according to the ACC/AHA and ADA definitions, respectively. Also, 22.9% (20.0, 26.1) did not have hypertension according to either definition, and the concordance in hypertension status was 89.2% (87.2, 91.0). Among U.S. adults with diabetes not taking antihypertensive medication, 52.8% (47.7, 57.8) were not recommended to initiate antihypertensive medication by either the ACC/AHA or the ADA document and 22.4% (19.2, 25.9) were recommended to initiate it by both documents (overall concordance 75.2% [70.4, 79.4]). Among those taking antihypertensive medication, 45.3% (41.3, 49.4) and 50.4% (46.5, 54.2) had BP above the goal in neither and both documents, respectively (overall concordance 95.7% [93.4, 97.2]).

Conclusions: A high percentage of U.S. adults with diabetes are provided identical antihypertensive treatment recommendations by the ACC/AHA BP guideline and the ADA diabetes and hypertension position statement.

Figure 1

Percentage of U.S. adults with diabetes who have hypertension (left panel), who are recommended to initiate antihypertensive medication (middle panel), and with above-goal BP among those taking antihypertensive medication (right panel). Estimates from NHANES 2011–2016 data using definitions from the 2017 ACC/AHA BP guideline and the ADA diabetes and hypertension position statement. Supplementary Table 1 contains the 95% CIs for the percentages presented in this figure.

Figure 2

Number of U.S. adults with diabetes who have hypertension (left bar), who are recommended to initiate antihypertensive medication among those not taking it (middle bar), and with above-goal BP among those taking antihypertensive medication (right bar) according to the 2017 ACC/AHA BP guideline and the ADA diabetes and hypertension position statement. Numbers in the figure are point estimates in millions with 95% CIs in parentheses.†Recommended antihypertensive medication initiation among those not taking antihypertensive medication. ††Recommended antihypertensive medication intensification due to above-goal BP (see Table 1 for the definitions of above-goal BP) among those taking antihypertensive medication.