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New BP guideline could change diagnosis for millions

Monday March 31, 2014
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Applying the updated 2014 blood pressure guideline to the U.S. population suggests that nearly 6 million adults are no longer classified as needing hypertension medication, and an estimated 13.5 million adults would now be considered as having achieved their BP goal, according to a study.

The reclassification primarily affects older adults, according to the study, which was published March 29 on the website of the Journal of the American Medical Association and presented at the American College of Cardiology’s scientific sessions in Washington, D.C.

Ann Marie Navar-Boggan, MD, PhD, of Duke University Medical Center, Durham, N.C., and colleagues quantified the proportion of adults potentially affected by the updated 2014 recommendations, compared with the previous guideline, which was issued nearly 10 years ago. The researchers used data from 16,372 participants in the National Health and Nutrition Examination Survey between 2005 and 2010 and evaluated hypertension control and treatment recommendations for U.S. adults.

The new guideline (http://jama.jamanetwork.com/article.aspx?articleid=1791497) proposed less restrictive BP targets for adults ages 60 and older and for those with diabetes and chronic kidney disease.

The authors estimated that the proportion of U.S. adults considered to have treatment-eligible hypertension would decrease from 20.3% under the previous guideline to 19.2% under the 2014 BP guideline among those ages 18 to 59, and from 68.9% to 61.2% among those ages 60 and older.

Extrapolating these numbers to the population represented by this NHANES sample — all U.S. adults in 2007 — translates to a reduction of 5.8 million adults classified as needing hypertension medication (from 70 million under the previous guideline to 64.2 million under the 2014 guideline).

The proportion of adults with treatment-eligible hypertension who met BP goals also increased from 41.2% to 47.5% among adults ages 18 to 59, and from 40% to 65.8% among adults ages 60 and older.

The authors estimate that 13.5 million adults not previously considered to be meeting BP targets would be considered at goal BP under the new guideline, affecting mostly those ages 60 and older, many of whom have diabetes, chronic kidney disease and cardiovascular disease.

Overall, 1.6% of U.S. adults ages 18 to 59 and 27.6% of those ages 60 and older were receiving BP-lowering medication and meeting the more stringent targets in the previous guidelines. These patients may be eligible for less stringent or no BP therapy with the 2014 BP guideline.

“Public health messaging should target the large number of adults in the United States with changing recommendations under the new guideline to ensure that new recommendations do not result in unintended consequences in adults now with ‘relabeled’ BP status,” the authors wrote. “Further research is needed to determine how this new guideline affects overall BP levels attained and to determine the related effects on cardiovascular disease outcomes.”

Harlan M. Krumholz, MD, SM, of the Yale University School of Medicine in New Haven, Conn., wrote in an accompanying editorial that these new guidelines, with their innovations and controversy, have established a new course.

“Navigating it may be uncomfortable and will perhaps force clinicians to grapple with issues that have been ignored for too long,” Krumholz wrote. “While it is important to advocate for health and promote healthy environments and behaviors on the broader scale, for medical decision making, it is even more important to ensure informed choice with the full participation of the person who will incur the risks and benefits of the decision.

“When viewed through this lens, the controversies about the guidelines become less contentious and the focus shifts to refining the evidence and producing better ways to communicate what is known for decision-making purposes. By directing attention to that message, already firmly embedded in these guidelines with their bold recommendations and deference to patient preference, they may have accomplished more than they ever envisioned.”

Study: http://jama.jamanetwork.com/article.aspx?articleid=1853202


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