Implications of new hypertension guidelines in the United States

Abstract

The American Heart Association released a scientific statement based on available clinical trials and expert opinion in 2007 for the treatment of hypertension to prevent coronary artery disease. These guidelines recommend more aggressive control of blood pressure (BP <130/80 mm Hg) among those at high risk for coronary artery disease, individuals with diabetes mellitus, chronic kidney disease, coronary artery disease or coronary artery disease risk equivalent, or a 10-year Framingham risk score >/=10%. Based on newer clinical trial data, the 2011 American College of Cardiology Foundation/American Heart Association (AHA) hypertension guidelines for the elderly recommend a less aggressive approach of <145/90 mm Hg in those over the age of 80 years. We estimated the burden of uncontrolled BP among those at an increased risk of coronary artery disease using the both the 2007 AHA and the 2011 American College of Cardiology Foundation/AHA hypertension guidelines. We used a cross-sectional analysis of National Health and Nutrition Examination Survey 2005-2008 participants. Participants were 10198 adults aged 18 to 85 years. Using the 2011 American College of Cardiology Foundation/AHA hypertension guidelines (>/=140/90 mm Hg), 72 million Americans (35%) have hypertension. Using the 2007 AHA guidelines, an additional 7 million American adults (5%) have elevated BP requiring treatment, for a total of 79 million adults (40%). Although individuals at a higher risk for coronary artery disease are more likely to be aware of their hypertension and to be taking antihypertension medication, they are less likely to have their BP under control. Additional efforts are needed in the treatment of elevated BP, especially among individuals with an increased risk of coronary artery disease.