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Potential need for expanded pharmacologic treatment and lifestyle modification services under the 2017 ACC/AHA
Matthew D Ritchey1, Cathleen Gillespie1, Gregory Wozniak2
1Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
The 2017 hypertension guideline impacts millions more US adults, including those with limited healthcare access. This guideline expands blood pressure management recommendations, affecting treatment and lifestyle modification needs.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The 2017 ACC/AHA Hypertension Guideline significantly expands the number of US adults requiring blood pressure (BP) management.
- Previous hypertension guidelines, such as JNC-7, had different criteria for BP management.
Purpose of the Study:
- To describe the population groups most affected by the 2017 hypertension guideline compared to JNC-7.
- To analyze prior healthcare interactions among adults recommended for new or intensified treatment under the 2017 guideline.
Main Methods:
- Utilized data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES).
- Compared population groups and healthcare interactions under the 2017 ACC/AHA Hypertension Guideline versus the JNC-7 guideline.
Main Results:
- The 2017 guideline reclassifies 32.3 million US adults as newly hypertensive.
- Recommends BP treatment for 133.7 million adults, with 57.8 million needing pharmacologic treatment and 50.5 million lifestyle modification.
- 13.1 million adults needing pharmacologic treatment and 20.6 million needing lifestyle modification report no established healthcare linkages.
Conclusions:
- The 2017 Hypertension Guideline increases the number of US adults needing BP treatment initiation or intensification.
- Alters the distribution of adults requiring BP management, identifying millions with limited prior healthcare interaction now needing intervention.
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.
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