Potential US Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline.
Level 4 - case-series / case-control
Cross-sectional survey analysis of nationally representative population data
PubMed 29133599 · doi:10.1161/CIRCULATIONAHA.117.032582
What was done
The authors analyzed cross-sectional data from 9,623 US adults in the 2011 to 2014 National Health and Nutrition Examination Survey (NHANES). Blood pressure (BP) was measured 3 times following a standardized protocol and averaged. Results were weighted to produce US population estimates comparing the 2017 ACC/AHA guideline against the JNC7 guideline for hypertension prevalence, medication recommendations, and treatment goal attainment.
What was found
Compared with the JNC7 guideline, the 2017 ACC/AHA guideline showed: - Crude hypertension prevalence among US adults was 45.6% (95% CI: 43.6% to 47.6%) versus 31.9% (95% CI: 30.1% to 33.7%). - Antihypertensive medication was recommended for 36.2% (95% CI: 34.2% to 38.2%) versus 34.3% (95% CI: 32.5% to 36.2%) of US adults. - Nonpharmacological intervention alone was advised for 9.4% of US adults with hypertension. - Among US adults taking antihypertensive medication, 53.4% (95% CI: 49.9% to 56.8%) had BP above the treatment goal versus 39.0% (95% CI: 36.4% to 41.6%).
Why it matters
This study quantified the population-level impact of the 2017 ACC/AHA guideline, showing it substantially increased hypertension prevalence and the need for more intensive BP lowering among treated patients, while resulting in only a small increase in the proportion recommended for medication.
Limits
Data were cross-sectional and relied on blood pressure measurements from a single examination visit, whereas clinical diagnosis requires elevated readings across multiple visits. The study modeled theoretical guideline application rather than assessing actual clinical practice patterns, patient adherence, or longitudinal cardiovascular outcomes.
Cited by
- supports In the United States, a blood pressure reading of 120/80 mmHg is classified as stage 1 hypertension, and clinical guideline changes reclassified 31 million people into the hypertension category overnight.