Potential need for expanded pharmacologic treatment and lifestyle modification services under the 2017 ACC/AHA Hypertension Guideline

Abstract

Application of the 2017 ACC/AHA Hypertension Guideline expands the number of US adults requiring blood pressure (BP) management. The authors use 2011-2014 NHANES data to describe the population groups most affected by the new guideline, compared with the previous JNC-7 guideline, and describe the previous interaction with the health care sector among those adults recommended new or intensified pharmacologic treatment and/or lifestyle modification. The 2017 Hypertension Guideline reclassifies 32.3 million US adults as newly hypertensive and recommends BP-related treatment of 133.7 million adults, including 57.8 million with uncontrolled BP recommended to initiate or intensify pharmacologic treatment and 50.5 million newly recommended lifestyle modification alone. An estimated 13.1 million (22.7%) adults recommended to initiate or intensify pharmacologic treatment, and 20.6 million (40.8%) adults newly recommended lifestyle modification alone report not having established health care linkages. Among the adults newly recommended lifestyle modification alone, the odds of reclassification from no recommended intervention, under JNC-7, to recommended lifestyle modification alone were lower for adults with established linkages to care (aOR: 0.78 [95% CI: 0.67-0.91]) compared to those without, decreased with increasing age, were greater for men (1.72 [1.52-1.94]) compared to women and were greater for obese adults (1.23 [1.00-1.53]) compared with normal or underweight adults. Application of the 2017 Hypertension Guideline increases the number and alters the distribution of US adults in need of initiating or intensifying BP treatment. This includes identifying millions of US adults who previously had limited interaction with health care and are now recommended new or intensified pharmacologic treatment and/or lifestyle modification.

Keywords: American Medical Association; Clinical management of high blood pressure; hypertension general; lifestyle modification/hypertension; or American Heart Association.

Figure 1

Number of US Adults Recommended Pharmacologic Treatment and/or Lifestyle Modification to Manage their Blood Pressure, By Recommended Treatment Type and Established Linkages to Care Status^a, National Health and Nutrition Examination Survey, 2011‐2014 (N = 133.7 million). BP: blood pressure. (a) Hatched sections represent the percentage of the specified population who reported having limited established linkages to care, defined as being uninsured, not having a usual source of care, or having had no health care visits during the past year. (b) Controlled BP defined as treated SBP <130 mm Hg and DBP <80 mm Hg

Figure 2

Prevalence of treatment status and blood pressure category^a, by recommended treatment status type—2017 Hypertension Guideline, National Health and Nutrition Examination Survey, 2011‐2014. ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CVD, cardiovascular disease. ^aBlood pressure categories include normal BP: untreated systolic BP (SBP) <120 mm Hg and diastolic BP (DBP) <80 mm Hg; elevated BP: untreated SBP 120‐129 mm Hg and DBP <80 mm Hg; controlled BP: treated SBP <130 mm Hg and DBP <80 mm Hg; uncontrolled Stage 1 hypertension: treated or untreated SBP 130‐139 mm Hg or DBP 80‐89 mm Hg; and uncontrolled Stage 2 hypertension: treated or untreated SBP ≥140 mm Hg or DBP ≥90 mm Hg