Author + information
- Received October 8, 2017
- Revision received October 25, 2017
- Accepted October 31, 2017
- Published online November 13, 2017.
- 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 of Cleveland Medical Center, Cleveland, Ohio
- gDepartment of Epidemiology, Tulane University, New Orleans, Lousiana
- ↵∗Correspondence: Paul Muntner, PhD Department of Epidemiology School of Public Health University of Alabama at Birmingham 1700 University Boulevard, Suite 450 Birmingham, Alabama 35294 Telephone: (205) 975-8077 Fax: 205-975-7058.
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.
Objective Determine the prevalence of hypertension, implications of recommendations for antihypertensive medication and prevalence of BP above the treatment goal among US adults using criteria from the 2017 ACC/AHA and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) guidelines.
Methods We analyzed data from the 2011-2014 National Health and Nutrition Examination Survey (N=9,623). NHANES participants completed study interviews and an examination. For each participant, blood pressure was measured three times following a standardized protocol and averaged. Results were weighted to produce US population estimates.
Results According to the 2017 ACC/AHA and JNC7 guidelines, the overall crude prevalence of hypertension among US adults was 45.6% (95% confidence interval [CI] 43.6%,47.6%) and 31.9% (95%CI 30.1%, 33.7%), respectively, and antihypertensive medication was recommended for 36.2% (95%CI 34.2%, 38.2%) and 34.3% (32.5%, 36.2%) of US adults, respectively. Compared to US adults recommended antihypertensive medication by JNC7, those recommended treatment by the 2017 ACC/AHA guideline but not JNC7 had higher CVD risk. Non-pharmacological intervention is advised for the 9.4% of US adults with hypertension according to the 2017 ACC/AHA guideline who are not recommended antihypertensive medication. Among US adults taking antihypertensive medication, 53.4% (95%CI 49.9%, 56.8%) and 39.0% (95%CI 36.4%, 41.6%) had BP above the treatment goal according to the 2017 ACC/AHA and JNC7 guidelines, respectively. Overall, 103.3 (95%CI 92.7, 114.0) million US adults had hypertension according to the 2017 ACC/AHA guideline of whom 81.9 (95%CI 73.8, 90.1) million were recommended antihypertensive medication.
Conclusion Compared with the JNC 7 guideline, the 2017 ACC/AHA guideline results in a substantial increase in the prevalence of hypertension but a small increase in the percentage of U.S. adults recommended antihypertensive medication. A substantial proportion of US adults taking antihypertensive medication is recommended more intensive BP lowering under the 2017 ACC/AHA guideline.
Disclosure: Dr. Muntner has received research support and honoraria from Amgen, Inc. unrelated to this manuscript. All other authors report no disclosures.
- Received October 8, 2017.
- Revision received October 25, 2017.
- Accepted October 31, 2017.