Millions More Labeled as Hypertensive Under 2017 Guidelines

By Joe Elia

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Adopting the 2017 ACC/AHA guidelines on hypertension would label almost two thirds of Americans between ages 45 and 75 as having the condition, according to a BMJ study, which calls the guidelines "not firmly rooted in evidence."

Researchers compared the number of people defined as hypertensive under the ACC/AHA guidelines (130 mm Hg or more systolic; or 80 or more diastolic) versus the number so defined under the widely used JNC-8 criteria (140 and 90 mm Hg, respectively). They examined the implications in both the U.S. and China using national databases.

Under the newer guidelines, the U.S. would add an estimated 15 million people labeled with hypertension in the 45-to-75-year age group, half of whom would be considered candidates for treatment. China would add more than 80 million.

The authors worry that under the ACC/AHA guidelines, "millions are at risk of psychological morbidity due to the label of a chronic disease, as well as for adverse events due to potential inappropriate use of drug therapy."

[Editors' note: Dr. Harlan Krumholz, the senior author of the paper under discussion, is editor-in-chief of NEJM Journal Watch Cardiology. He had no role in choosing the paper for coverage, nor was he consulted about this story.]