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Fewer adults eligible for hypertension treatment under 2014 BP guidelines
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The 2014 BP guideline released by panel members of the Eighth Joint National Committee lowers the percentage of adults in the United States who meet the criteria for hypertension treatment and significantly increases the percentage of patients considered to have met their target BP goal, particularly among older patients, according to recent findings.
Researchers evaluated data on 16,372 patients enrolled in the National Health and Nutrition Examination Survey, including BP measurements and patient-disclosed use of BP medications between 2005 and 2010. They estimated the percentage of adults with treatment-eligible hypertension based on the guidelines issued by both the Seventh Joint National Committee (JNC 7) and the 2014 Eighth committee (JNC 8). These estimates were stratified by age (18 to 59 years, and 60 years and older), treatment status and the presence or absence of comorbidities such as diabetes or chronic kidney disease (CKD).
Under the JNC 7 guideline, the percentage of younger adults (aged 18-59 years) with treatment-eligible hypertension was 20.3%, which decreased to 19.2% under the new guideline. The reduction was more pronounced among adults aged 60 years or older, with a decrease from 68.9% eligibility under JNC 7 to 61.2% under JNC 8.
The percentage of treatment-eligible hypertension patients who met BP goals increased slightly under JNC 8 in the younger adult population, from 41.2% under JNC 7 to 47.5%. This increase was more pronounced in older adults: from 40% under JNC 7 to 65.8% under the 2014 BP guideline.
The researchers estimated that 1.6% of US adults aged 18 to 59 years and 27.6% of adults aged 60 years or older were on BP-lowering treatment regimens and meeting the stricter JNC 7 BP goals. Under the 2014 guideline, they wrote, these patients may have achieved the new BP targets with reduced or possibly no therapy.
“We estimate that, compared with the JNC 7 guideline, the 2014 BP guideline … was associated with a decrease in overall rates of treatment-eligible hypertension from 31.7% under JNC 7 to 29%,” the researchers concluded. “… Further research is needed to determine how this new guideline affects overall BP levels attained and to determine the related effects on CVD outcomes.”
Harlan M. Krumholz
In an accompanying editorial, Harlan M. Krumholz, MD, of Yale University School of Medicine, wrote that these guidelines should serve to foster informed decision-making.
“These guidelines, with their innovations and controversy, have established a new course,” 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.”
For more information:Krumholz HM. JAMA. 2014;311:1403-1405.
Navar-Boggan AM. JAMA. 2014;311:1424-1429.
Disclosure: One researcher reports receiving research grant funding from Janssen and Eli Lilly, as well as compensation for consulting services from Janssen and Boehringer Ingelheim. Krumholz reports receiving research grants from Medtronic and Johnson & Johnson through Yale University, and is chair of a cardiac scientific advisory board for UnitedHealth.