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Uncontrolled hypertension by the 2014 evidence-based guideline: results from NHANES 2011-2012

Ankit Sakhuja1, Stephen C Textor, Sandra J Taler

  • 1Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Journal of Hypertension
|December 6, 2014
PubMed

Insights

The 2014 evidence-based guideline (2014 EBG) shows lower uncontrolled hypertension prevalence (12.8%) than JNC 7 (16.6%). This reclassification impacts elderly, females, and those with diabetes, reflecting updated blood pressure targets.

Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Hypertension prevalence and control are critical public health concerns.
  • Existing hypertension guidelines, including Seventh Joint National Committee (JNC 7), differ in their targets and classifications.
  • The 2014 evidence-based guideline (2014 EBG) introduced updated blood pressure targets, necessitating an evaluation of its impact on hypertension prevalence.

Purpose of the Study:

  • To determine the prevalence of uncontrolled hypertension using multiple guidelines (JNC 7, ESH/ESC, CHEP, and 2014 EBG).
  • To assess predictors for reclassification to controlled hypertension under the 2014 EBG compared to JNC 7.
  • To understand the demographic and clinical factors influencing changes in hypertension status.

Main Methods:

  • Analysis of the National Health and Nutrition Examination Survey (NHANES) 2011-2012 data.
  • Prevalence of uncontrolled hypertension calculated using JNC 7, ESH/ESC, CHEP, and 2014 EBG criteria.
  • Multivariable logistic regression used to identify predictors of reclassification to controlled hypertension by the 2014 EBG.

Main Results:

  • The 2014 EBG identified a lower prevalence of uncontrolled hypertension (12.8%) compared to JNC 7 (16.6%), ESH/ESC (13.6%), and CHEP (15.6%).
  • Approximately 23.0% of individuals classified as having uncontrolled hypertension under JNC 7 were reclassified as controlled under the 2014 EBG.
  • Older age, female sex, and presence of diabetes were significant predictors for reclassification to controlled hypertension.

Conclusions:

  • The 2014 EBG results in a lower estimated prevalence of uncontrolled hypertension in the US population (12.8% vs. 16.6% by JNC 7).
  • This shift is primarily due to revised blood pressure targets, not an improvement in actual blood pressure control levels.
  • Elderly individuals, females, and those with diabetes are most affected by this reclassification, highlighting specific populations for targeted management.
Abstract

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