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JAMA. 2014 Apr 9;311(14):1424-9. doi: 10.1001/jama.2014.2531.

Proportion of US adults potentially affected by the 2014 hypertension guideline.

Author information

1
Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
2
DCRI, Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.
3
KenAnCo Biostatistics, San Antonio, Texas.
4
Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
5
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina6Associate Editor, JAMA.

Erratum in

  • JAMA. 2014 Aug 27;312(8):848.

Abstract

IMPORTANCE:

The new 2014 blood pressure (BP) guideline released by the panel members appointed to the Eighth Joint National Committee (JNC 8; 2014 BP guideline) proposed less restrictive BP targets for adults aged 60 years or older and for those with diabetes and chronic kidney disease.

OBJECTIVE:

To estimate the proportion of US adults potentially affected by recent changes in recommendations for management of hypertension.

DESIGN:

Cross-sectional, nationally representative survey.

PARTICIPANTS:

Using data from the National Health and Nutrition Examination Survey between 2005 and 2010 (nā€‰=ā€‰16,372), we evaluated hypertension control and treatment recommendations for US adults.

MAIN OUTCOMES AND MEASURES:

Proportion of adults estimated to meet guideline-based BP targets under the 2014 BP guideline and under the previous seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guideline.

RESULTS:

The proportion of younger adults (18-59 years) with treatment-eligible hypertension under the JNC 7 guideline was 20.3% (95% CI, 19.1%-21.4%) and decreased to 19.2% (95% CI, 18.1%-20.4%) under the 2014 BP guideline. Larger declines were observed among older adults (ā‰„60 years), decreasing from 68.9% (95% CI, 66.9%-70.8%) under JNC 7 to 61.2% (95% CI, 59.3%-63.0%) under the 2014 BP guideline. The proportion of adults with treatment-eligible hypertension who met BP goals increased slightly for younger adults, from 41.2% (95% CI, 38.1%-44.3%) under JNC 7 to 47.5% (95% CI, 44.4%-50.6%) under the 2014 BP guideline, and more substantially for older adults, from 40.0% (95% CI, 37.8%-42.3%) under JNC 7 to 65.8% (95% CI, 63.7%-67.9%) under the 2014 BP guideline. Overall, 1.6% (95% CI, 1.3%-1.9%) of US adults aged 18-59 years and 27.6% (95% CI, 25.9%-29.3%) of adults aged 60 years or older were receiving BP-lowering medication and meeting more stringent JNC 7 targets. These patients may be eligible for less stringent or no BP therapy with the 2014 BP guideline.

CONCLUSIONS AND RELEVANCE:

Compared with the JNC 7 guideline, the 2014 BP guideline from the panel members appointed to the JNC 8 was associated with a reduction in the proportion of US adults recommended for hypertension treatment and a substantial increase in the proportion of adults considered to have achieved goal BP, primarily in older adults.

PMID:
24682242
DOI:
10.1001/jama.2014.2531
[Indexed for MEDLINE]

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