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Original Investigation |

Proportion of US Adults Potentially Affected by the 2014 Hypertension Guideline

Ann Marie Navar-Boggan, MD, PhD1; Michael J. Pencina, PhD2; Ken Williams, MS3; Allan D. Sniderman, MD4; Eric D. Peterson, MD, MPH5,6
[+] Author Affiliations
1Division of Cardiology, Duke University Medical Center, Durham, North Carolina
2DCRI, Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
3KenAnCo Biostatistics, San Antonio, Texas
4Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
5Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
6Associate Editor, JAMA
JAMA. 2014;311(14):1424-1429. doi:10.1001/jama.2014.2531.
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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 (n = 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 (≥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.

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Treatment-Eligible Hypertension and Adults With Above-Goal BP According to JNC 7 and the 2014 Blood Pressure Guideline

Proportion of all adults aged 18-59 years and aged 60 years or older considered eligible for medication treatment, and the proportion of adults with treatment-eligible hypertension who met BP goals according to JNC 7 and the 2014 blood pressure guideline. Medication-eligible hypertension is defined as receiving therapy or above goal for each guideline. NHANES indicates National Health and Nutrition Examination Survey. Percentages and 95% CIs (error bars) are weighted.

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