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Sharp rise in people labelled as hypertensive under new guidelines

62.5 million more people could become eligible for drug treatment

Adrian O'Dowd

Thursday, 12 July 2018

New guidelines for hypertension, if adopted in the USA and China, could mean more than 62 million additional people could become eligible for drug treatment, according to a study* published today by The BMJ.

A study by US and Chinese researchers found that new guidelines would mean that more than half of those people aged 45-75 years in both countries would be considered hypertensive for the first time.

There are an estimated 16 million people in the UK who have high blood pressure, defined as being at a level consistently at or above 140mmHg and/or 90mmHg.

The American College of Cardiology (ACC) and the American Heart Association (AHA) recently released guideline recommendations for hypertension with lower blood pressure values used to define elevated blood pressure, and lower treatment thresholds – a systolic blood pressure of 130 mmHg or greater or a diastolic blood pressure of 80 mmHg or greater – than those recommended in current guidelines.

While the impact of changes in guideline recommendations has been evaluated in the US, less is known about how they translate to other populations. China, in particular, has high levels of hypertension and has the world’s largest population.

Therefore, a team of researchers led by Professor Harlan Krumholz at Yale School of Medicine, in the US, set out to examine the effect of the 2017 ACC/AHA guidelines on the prevalence of hypertension and eligibility for new and more intensive treatment in the US and China.

For their study, they analysed nationally representative data for adults aged 45 to 75 from the US and China who would have a diagnosis of hypertension and be candidates for treatment on the basis of the ACC/AHA guidelines, compared with current guidelines.

Results showed that adoption of the guidelines would dramatically increase the number of people with hypertension and those recommended for treatment.

They calculated that, in the US, the new guidelines would classify 70 million people in the 45-75 year age group as having hypertension – representing 63% of the population in this age group.

Adoption of these guidelines in China would lead to the classification of 267 million (55%) people in the same group as having hypertension.

This would represent a relative increase of 27% in the US and 45% in China compared with current recommendations, said the researchers.

Based on these calculations, 7.5 million people in the US and 55.3 million people in China would be advised to start drug treatment, while 13.9 million in the US and 30 million in China would be advised to receive more intensive drug treatment.

The researchers pointed out that the study focused only on those aged 45-75 years, so additional people of different ages in both countries could have hypertension and also be candidates for treatment.
They conclude: “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.”

*Khera, R, Lu, Y, Lu, J, et al. 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. BMJ 2018;362:k2357. DOI:10.1136/bmj.k2357

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