Bundy JD, et al. - Researchers assessed the possible correlation of the 2017 and 2014 hypertension guidelines with the percentage of US adults defined as being hypertensive or recommended for antihypertensive treatment and with risk reduction of major cardiovascular disease (CVD) and all-cause mortality. They reported an increase in the percentage of adults recommended for antihypertensive treatment and a reduction in major CVD events and all-cause mortality, but a possible increase in the number of adverse events in the US associated with the 2017 hypertension guideline vs the 2014 hypertension guideline.

Methods

• Researchers estimated the proportions of US adults with hypertension or recommended for antihypertensive treatment according to the 2017 and 2014 hypertension guidelines, using data from the National Health and Nutrition Examination Survey 2013 to 2016.
• They estimated risk reductions of CVD and all-cause mortality (assuming the entire US adult population achieved guideline-recommended systolic BP treatment goals) by using data from the National Health and Nutrition Examination Survey, antihypertensive clinical trials, and population-based cohort studies.
• They carried out data analysis between October 2017 and March 2018.
• They estimated the proportions and numbers of individuals with hypertension or recommended for antihypertensive treatment and numbers of CVD and all-cause mortality reduction as main outcomes and measures.

Results

• The estimated prevalence of hypertension according to the 2017 hypertension guideline (BP level ≥ 130/80 mm Hg) was 45.4% (95% CI, 43.9%-46.9%), representing 105.3 (95% CI, 101.9-108.8) million US adults, which was significantly higher than estimates per the 2014 hypertension guideline (BP level ≥ 140/90 mm Hg): 32.0% (95% CI, 30.3%-33.6%) or 74.1 (95% CI, 70.3-77.9) million individuals, respectively.
• With regard to the proportion of individuals recommended for antihypertensive treatment, a significantly higher proportion was documented according to the 2017 hypertension guideline (35.9%; 95% CI, 34.2%-37.5%) vs the 2014 hypertension guideline (31.1%; 95% CI, 29.6%-32.7%).
• An estimated reduction of 610,000 (95% CI, 496,000-734,000) CVD events and 334,000 (95% CI, 245,000-434,000) total deaths in US adults 40 years and older was approximated in relation to achieving the 2017 hypertension guideline SBP treatment goals.
• After achieving the 2014 hypertension guideline SBP treatment goals, the corresponding estimates were 270,000 (95% CI, 202,000-349,000) and 177,000 (95% CI, 123,000-241,000), respectively.
• Data suggested that with the implementation of the 2017 hypertension guideline, 62,000 hypotension and 79,000 acute kidney injury or failure events have been estimated to be increased.