Controversial 2017 hypertension guidelines could save 300K lives every year

Researchers said the number of U.S. adults with hypertension would grow by 31 million and the number of adults recommended for antihypertensive treatment would increase by 11 million, based on the 2017 blood pressure guidelines issued by American College of Cardiology/American Heart Association (ACC/AHA). A new analysis of the potential impact of these guidelines was published in JAMA Cardiology on May 23.

The researchers, led by first author Jiang He, MD, PhD, of Tulane University School of Public Health and Tropical Medicine in New Orleans sought to estimate the effects of both the 2017 and 2014 hypertension guidelines on proportions of adults defines as having high blood pressure or recommended for antihypertensive treatment and reductions in cardiovascular disease and mortality.

The controversial 2017 guidelines were issued in November and define hypertension as blood pressure greater than or equal to 130/80 mmHg. Previous guidelines issued in 2014 defined hypertension as blood pressure greater than or equal to 140/90 mmHg.

He et al. found the prevalence of hypertension among U.S. adults, according to the 2017 hypertension guideline, was approximately 45 percent, which represents 105 million U.S. adults. Prevalence of hypertension among U.S. adults according to the 2014 hypertension guideline was 32 percent, representing 74 million adults.

“Given the linear association between BP levels and risk of CVD and all-cause mortality, lower BP thresholds might be justifiable,” the authors wrote. “The new criteria increase the number of adults who would be newly diagnosed as hypertensive and receive lifestyle interventions and antihypertensive medication treatment. However, the new criteria also result in an increased number of adults diagnosed as hypertensive who might not be expected to develop CVD events. The health and economic consequences of the new diagnostic criteria for hypertension should be evaluated in future studies.”

The proportion of individuals recommended for antihypertensive treatment was significantly higher according to the 2017 hypertension guideline, compared to the 2014 guideline.

Assuming there is 100 percent compliance of the 2017 guidelines among the U.S. adult population, the researchers estimated there would be 610,000 fewer non-fatal CVD events (i.e. myocardial infarction, stroke) and 334,000 fewer total deaths in U.S. adults, 40 years and older. And 50 percent achievement of the 2017 hypertension guidelines would result in a reduction of only 305,000 non-fatal CVD events and 167,000 total deaths in U.S.

Interestingly, a 75 percent achievement of 2014 hypertension guidelines would reduce only 203,000 non-fatal CVD events and 133,000 total deaths—making 50 percent achievement of 2017 guidelines more effective in reduction of additional CVD-related events and death than 75 percent achievement of 2014 guidelines.

The researchers used data from the National Health and Nutrition Examination Survey (NHANES) to estimate the proportions of U.S. adults with hypertension or recommended for antihypertensive treatment according to the 2017 and 2014 hypertension guidelines. They also combined the NHANES along with antihypertensive clinical trials and population-based cohort studies to estimate the risk reductions of CVD and death assuming the entire U.S. adult population were compliant with the 2017 guidelines.

“While both estimates are based on several assumptions, the major message is that the more complete achievement of either guideline treatment goal substantially reduces CVD events in the United States,” wrote George A. Mensah, MD, and colleagues, not related to the study, in an accompanying editorial.