Uphill Climb Seen for Implementation of US Blood Pressure Guidelines

Expanding the number of people deemed hypertensive could strain healthcare resources in the US and, if it adopts the guidance, China.

Putting the impact of the new hypertension guidelines from the American College of Cardiology (ACC), American Heart Association (AHA), and nine partnering organizations into an international context, a new study has shown that if China were to adopt the guidance, it would—like in the United States—dramatically expand the ranks of people considered to have high blood pressure and to be candidates for treatment.

The US guidance—released in November 2017—lowered the recommended treatment goal to below 130/80 mm Hg across patient groups and changed the classification of BP levels, with stage 1 hypertension starting at a systolic pressure of at least 130 mm Hg or a diastolic pressure of at least 80 mm Hg. 

In the new study, Rohan Khera, MD (UT Southwestern Medical Center, Dallas, TX), and colleagues show that more than half (55%) of people ages 45 to 75 in China would be classified as hypertensive, up from 38.0% under prior recommendations. That compares with 63% of Americans in that age group—up from 49.7%—who would meet the new hypertension definition.

This “raises the question of whether this sort of expansion of the definition, while well intended, is going to end up sort of diffusing the focus on the need to approach the people at highest risk,” senior author Harlan Krumholz, MD (Yale New Haven Hospital, CT), told TCTMD. “At a time when we can’t even keep up with a higher threshold for the definition of hypertension, it may be that we want to leave pushing lower as an option for people, but from a public health perspective we want to make sure that we’re taking care of the highest-risk people first,” he said.

Though prior studies have looked at what proportion of the US population would be considered hypertensive under the new guideline definition, this study—published online July 11, 2018, ahead of print in the BMJ—assessed the impact both in the United States and in China, where awareness, treatment, and control of hypertension remain poor.

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