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BMJ. 2018 Jul 11;362:k2357. doi: 10.1136/bmj.k2357.

Impact of 2017 ACC/AHA guidelines on prevalence of hypertension and eligibility for antihypertensive treatment in United States and China: nationally representative cross sectional study.

Author information

1
Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75219, USA.
2
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT 06510, USA.
3
National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 102308, China.
4
Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami Beach, FL 33139, USA.
5
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
6
State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 102308, China.
7
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT 06510, USA.

Abstract

OBJECTIVE:

To examine the effect of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines on the prevalence of hypertension and eligibility for initiation and intensification of treatment in nationally representative populations from the United States and China.

DESIGN:

Observational assessment of nationally representative data.

SETTING:

US National Health and Nutrition Examination Survey (NHANES) for the most recent two cycles (2013-14, 2015-16) and China Health and Retirement Longitudinal Study (CHARLS) (2011-12).

PARTICIPANTS:

All 45-75 year old adults who would have a diagnosis of hypertension and be candidates for treatment on the basis of the ACC/AHA guidelines, compared with current guidelines.

MAIN OUTCOME MEASURES:

Diagnosis of hypertension and candidacy for initiation and intensification of antihypertensive treatment.

RESULTS:

Adoption of the 2017 ACC/AHA hypertension guidelines in the US would label 70.1 (95% confidence interval 64.9 to 75.3) million people in the 45-75 year age group as having hypertension, representing 63% (60.6% to 65.4%) of the population in this age group. Their adoption in China would lead to labeling of 266.9 (252.9 to 280.8) million people or 55% (53.4% to 56.7%) of the same age group as having hypertension. This would represent an increase in prevalence of 26.8% (23.2% to 30.9%) in the US and 45.1% (41.3% to 48.9%) in China. Furthermore, on the basis of treatment patterns and current guidelines, 8.1 (6.5 to 9.7) million Americans with hypertension are untreated, which would be expected to increase to 15.6 (13.6 to 17.7) million after the implementation of the ACC/AHA guidelines. In China, on the basis of current treatment patterns, 74.5 (64.1 to 84.8) million patients with hypertension are untreated, estimated to increase to 129.8 (118.7 to 140.9 million. In addition, the ACC/AHA guidelines would label 8.7 (6.0 to 11.5) million adults in the US and 51 (40.3 to 61.6) million in China as having hypertension that would not require antihypertensive treatment, compared with 1.5 (1.2 to 2.1) million and 23.4 (12.1 to 35.1) million with the current guidelines. Finally, even among people receiving treatment, the proportion that are candidates for intensification of treatment is estimated to increase by 13.9 (12.2 to 15.6) million (from 24.0% to 54.4% of treated patients) in the US, and 30 (24.3 to 35.7) million (41.4% to 76.2% of treated patients) in China, if the ACC/AHA treatment targets are adopted.

CONCLUSIONS:

If adopted, the 2017 ACC/AHA hypertension guidelines will markedly increase the number of people labeled as having hypertension and treated with drugs in both the US and China, leading to more than half of those aged 45-75 years in both countries being considered hypertensive.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: RK is supported by the National Heart, Lung, and Blood Institute (5T32HL125247-02) and the National Center for Advancing Translational Sciences (UL1TR001105) of the National Institutes of Health; HMK is a recipient of research agreements from Medtronic and from Johnson and Johnson (Janssen), through Yale University, to develop methods of clinical trial data sharing, is the recipient of a grant from the Food and Drug Administration and Medtronic to develop methods for post-market surveillance of medical devices, works under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures, chairs a cardiac scientific advisory board for UnitedHealth, is a participant/participant representative of the IBM Watson Health Life Sciences Board, is on the Advisory Board for Element Science, is on the Physician Advisory Board for Aetna, and is the founder of Hugo, a personal health information platform; no other relationships or activities that could appear to have influenced the submitted work.

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