Author + information
- Received October 8, 2017
- Revision received October 25, 2017
- Accepted October 31, 2017
- Published online January 8, 2018.
- Paul Muntner, PhDa,∗ (, )
- Robert M. Carey, MDb,
- Samuel Gidding, MDc,
- Daniel W. Jones, MDd,
- Sandra J. Taler, MDe,
- Jackson T. Wright Jr., MD, PhDf and
- Paul K. Whelton, MB, MD, MScg
- aDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- bDepartment of Medicine, University of Virginia, Charlottesville, Virginia
- cNemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, Delaware
- dDepartment of Medicine, University of Mississippi, Jackson, Mississippi
- eDivision of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- fDivision of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- gDepartment of Epidemiology, Tulane University, New Orleans, Louisiana
- ↵∗Address for correspondence:
Dr. Paul Muntner, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1700 University Boulevard, Suite 450, Birmingham, Alabama 35294.
Background The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults provides recommendations for the definition of hypertension, systolic and diastolic blood pressure (BP) thresholds for initiation of antihypertensive medication, and BP target goals.
Objectives This study sought to determine the prevalence of hypertension, implications of recommendations for antihypertensive medication, and prevalence of BP above the treatment goal among U.S. adults using criteria from the 2017 ACC/AHA guideline and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7).
Methods The authors analyzed data from the 2011 to 2014 National Health and Nutrition Examination Survey (N = 9,623). BP was measured 3 times following a standardized protocol and averaged. Results were weighted to produce U.S. population estimates.
Results According to the 2017 ACC/AHA and JNC7 guidelines, the crude prevalence of hypertension among U.S. adults was 45.6% (95% confidence interval [CI]: 43.6% to 47.6%) and 31.9% (95% CI: 30.1% to 33.7%), respectively, and antihypertensive medication was recommended for 36.2% (95% CI: 34.2% to 38.2%) and 34.3% (95% CI: 32.5% to 36.2%) of U.S. adults, respectively. Nonpharmacological intervention is advised for the 9.4% of U.S. adults with hypertension who are not recommended for antihypertensive medication according to the 2017 ACC/AHA guideline. Among U.S. adults taking antihypertensive medication, 53.4% (95% CI: 49.9% to 56.8%) and 39.0% (95% CI: 36.4% to 41.6%) had BP above the treatment goal according to the 2017 ACC/AHA and JNC7 guidelines, respectively.
Conclusions Compared with the JNC7 guideline, the 2017 ACC/AHA guideline results in a substantial increase in the prevalence of hypertension, a small increase in the percentage of U.S. adults recommended for antihypertensive medication, and more intensive BP lowering for many adults taking antihypertensive medication.
Dr. Muntner has received research support through grant 15SFRN2390002 from the American Heart Association; and has received research support and honoraria from Amgen, Inc. unrelated to this paper. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
This article has been copublished in Circulation.
- Received October 8, 2017.
- Revision received October 25, 2017.
- Accepted October 31, 2017.
- 2018 American College of Cardiology Foundation and American Heart Association