Under 2017 Guideline, More Than 105 Million Americans Have Hypertension

The number of US adults who have high blood pressure could grow by as much as 31 million—and the number of adults who will be recommended for antihypertensive treatment could increase by 11 million—if full implementation of the American Heart Association’s 2017 hypertension guideline is reached.

Those findings come from an investigation published today in JAMA Cardiology, by a research team led by Joshua D. Bundy, PhD, MPH. The study estimated the potential association of the 2017 hypertension guidelines, versus the 2014 guidelines, with the proportion of US adults who were defined as having hypertension or who were recommended for treatment, as well as with risk reduction of major cardiovascular disease (CVD) and mortality.¹

Drawing on data from the National Health and Nutrition Examination Survey, antihypertensive clinical trials, and population-based cohort studies, the researchers estimated the risk reductions of CVD and all-cause mortality assuming the entire US adult population achieved guideline-recommended blood pressure treatment goals.

They found that, according to the 2017 guideline, 45.4% of US adults, or 105.3 million people, had hypertension. That number reflects a significant increase on estimates under the 2014 guideline, under which 32% of Americans, or 74.1 million people, would be classified as having hypertension, with the greatest difference apparent in men aged 40 to 50 years. Furthermore, under the 2017 guideline, 35.9% of US adults, or 83.2 million people, would be eligible for antihypertensive treatment (versus 31.1%, or 72.2 million people, under the 2014 guideline).

Among people for whom treatment is recommended under the 2017 guideline, 12.1% (27.9 million) people were untreated, 12.9% (29.9 million) were treated but have not achieved their blood pressure goal, and 10.9% (25.3 million) were treated and had achieved their blood pressure goal.

Compared with the 2014 version, the 2017 guideline is estimated to recommend slightly more men than women for treatment, with a 5.4% (6.0 million) increase in men and a 4.1% (5.0 million) increase in women. It also in recommends treatment to substantially more people over 60 years of age (a 10.5% increase, or 6.6 million people) than people under age 60 (a 2.6% increase, or 4.4 million people). Increases in the proportions of people recommended for treatment were similar by race and ethnicity.

If full implementation of the 2017 guideline were achieved, say the authors, an estimated 610,000 CVD events and 334,000 total deaths would be prevented each year in those aged 40 or older (versus 270,000 and 170,000, respectively, under the 2014 guideline). Thus, implementation could potentially prevent 340,000 CVD events and 156,000 deaths each year.

Writing in a linked editorial, Lawrence J. Fine, MD, DrPH, David C. Goff, MD, PhD, and George A. Mensah, MD, said that “these estimates remind us of how much remains to be done in reducing [blood pressure] levels in the United States and globally by more effective guideline implementation.” They noted that, in order to achieve widespread and effective implementation, the use of evidence-based strategies such as team-based care, is key, particularly for high-risk patient populations who have limited social and economic resources.

“Regardless of the guideline one prefers,” they wrote, “we can agree that improved detection, treatment, and control are national and global priorities.”

References

1. Bundy DJ, Mills KT, Chen J, Li C, Greenland P, He J. Estimating the association of the 2017 and 2014 hypertension guidelines with cardiovascular events and deaths in US adults: an analysis of national data. [Published online May 23, 2018.] JAMA Cardiol. doi: 10.1001/jamacardio.2018.1240.

2. Fine LJ, Goff DC, Mensah GA. Blood pressure control—much has been achieved, much remains to be done. [Published online May 23, 2018.] JAMA Cardiol. doi:10.1001/jamacardio.2018.1259.