New Blood Pressure Guidelines Free Many from Medication

A new study calculates that applying the updated 2014 blood pressure (BP) guideline to the US population would result in nearly six million adults are no longer classified as needing hypertension medication.

Researchers at Duke University Medical Center (Durham, NC, USA) used data regarding 16,372 patients between 2005 and 2010 to evaluate hypertension control and treatment recommendations for US adults. The researchers compared the previous seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guideline to the new 2014 JNC-8 guideline, which proposed less restrictive BP targets for adults 60 years of age or older and for those with diabetes and chronic kidney disease (CKD).

The results indicate that the proportion of younger adults with treatment-eligible hypertension under the JNC-7 guideline was 20.3%, which decreased to 19.2% under the 2014 BP guideline. Larger declines were observed among older adults (≥60 years), decreasing from 68.9% under JNC-7 to 61.2% under the 2014 BP guideline. The proportion of adults with treatment-eligible hypertension who met BP goals increased slightly for younger adults, from 41.2% under JNC-7 to 47.5% under the 2014 BP guideline, and more substantially for older adults, (from 40% to 65.8%, respectively).

The authors estimated that 13.5 million US adults not previously considered to be meeting BP targets would be considered at goal BP under the new guideline, with the majority affected age 60 years and older, including many of those that suffer from diabetes, CKD, and cardiovascular disease (CVD). In all, 1.6% of US adults aged 18–59 years and 27.6% of adults aged 60 years or older who were receiving BP-lowering medication may be eligible for less stringent or no BP therapy with the 2014 BP guideline. The study was published on March 28, 2015, in JAMA.

“Compared with the JNC-7 guideline, the 2014 BP guideline from the panel members appointed to the JNC-8 was associated with a reduction in the proportion of US adults recommended for hypertension treatment and a substantial increase in the proportion of adults considered to have achieved goal BP, primarily in older adults,” concluded lead author Ann Marie Navar-Boggan, MD, PhD, and colleagues. “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.”

The 2014 JNC-8 evidence-based guideline included some notable differences compared with the previous JNC 7 guideline. The 2014 BP guideline increased the systolic BP treatment goal from less than 140/90 mm Hg to less than 150/90 mm Hg, although committee members did not recommend it unanimously. Similarly, the 2014 BP guideline changed targets for adults with CKD and diabetes from less than 130/80 mm Hg to the less than 140/90 mm Hg target goal recommended for the general population.

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Duke University Medical Center