The Impact of 2017 ACC/AHA Guidelines on the Prevalence of Hypertension and Eligibility for Anti-Hypertensive Therapy in the United States and China

Abstract

BACKGROUNDThe 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline recommendations for hypertension include major changes to the diagnosis of hypertension as well as suggested treatment targets for blood pressure management. To better guide future health policy interventions in the management of hypertension, we examined the effect of these guidelines on the prevalence as well as the eligibility for initiation and intensification of therapy in nationally-representative populations from the US and China.\n\nMETHODSIn the National Health and Nutrition Examination Survey (NHANES) for the most recent 2 cycles (2013-2014 and 2015-2016), and the China Health and Retirement Longitudinal Study (CHARLS) (2011-2012), we identified all adults 45 to 75 years of age who would have a diagnosis of hypertension, and would be candidates for initiation and intensification of anti-hypertensive therapy based on the 2017 ACC/AHA guidelines, compared with current guidelines.\n\nRESULTSThe adoption of the 2017 ACC/AHA guidelines for hypertension in the US would label 70.1 million individuals in the 45-75-year age group with hypertension, representing 63% of the population in this age-group. The adoption of these guidelines in China would lead to labeling of 267 million or 55% individuals in the same age-group with hypertension. This would represent a relative increase in the prevalence of hypertension by 26.8% in the US and 45.1% in China with the adoption of the new guidelines. Further, based on observed treatment patterns and current guidelines, 8.1 million Americans with hypertension are currently untreated. However, this number is expected to increase to 15.6 million after the implementation of the 2017 ACC/AHA guidelines. In China, based on current treatment patterns, 74.5 million patients with hypertension are untreated, and is estimated to increase to 129.8 million if the 2017 ACC/AHA guidelines are adopted by China. In addition, the new ACC/AHA guidelines will label 8.7 million adults in the US, and 51 million in China with hypertension who would not require treatment with an anti-hypertensive agent, compared with 1.5 million and 23.4 million in the current guidelines. Finally, even among those treated with anti-hypertensive therapy, the proportion of undertreated individuals, i.e. those above target blood pressures despite receiving anti-hypertensive therapy and candidates for intensification of therapy, is estimated to increase by 13.9 million (from 24.0% to 54.4% of the treated patients) in the US, and 30 million (41.4% to 76.2% of patients on treatment) in China, if the 2017 ACC/AHA treatment targets are adopted into clinical practice in the respective countries.\n\nConclusionsAdopting the new 2017 ACC/AHA hypertension guidelines would be associated with a substantial increase in the prevalence of hypertension in both US and China accompanied with a marked increase in the recommendation to initiate and intensify treatment in several million patients. There would be a 26.8% and 45.1% increase in those labeled with hypertension in the US and China, respectively. Further, 7.5 million and 55.3 million will be newly recommended for therapy, and 13.9 million and 30 million newly recommended for intensification of existing therapy in the US and China, respectively.