Hypertension

BP guideline, 1 year later: 4 patient groups see biggest impact

The 2017 hypertension guideline classifies 44 percent of U.S. adults as having hypertension—a rise of 32.3 million compared with the previous guideline. Beyond that top-line number, though, research published in the Journal of Clinical Hypertension finds that four main patient groups were affected the most by the guideline.

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The 2017 hypertension guideline came from a joint task force formed by the American College of Cardiology (ACC) and the American Heart Association (AHA). The ACC and AHA partnered with many other organizations representing physicians and other health professionals to create the new guideline.

The guideline recommends BP-related treatment of 133.7 million adults, says the study, “Potential need for expanded pharmacologic treatment and lifestyle modification under the 2017 ACC/AHA Hypertension Guideline.” This includes a recommendation to initiate or intensify pharmacologic treatment in 57.8 million adults and newly recommended lifestyle modification alone for 50.5 million.

The AMA and the AHA partnered to launch Target: BP™ to improve blood pressure control. In addition to direct access to trained field support specialists, a data platform and a suite of evidenced-based tools and resources offered by the AMA and the AHA, Target: BP offers annual, recurring recognition for all participating sites that achieve hypertension control rates of 70 percent or higher among their adult patient population year over year.

Here are four groups most affected by reclassification of their hypertension, treatment and BP control status with application of the new guideline, according to the study, co-written by Gregory Wozniak, PhD, director of outcomes analytics in Improving Health Outcomes at the AMA.

Those with limited access to care. Among adults with newly recommended lifestyle modification alone, about 41 percent (20.6 million) did not have established linkages to care. This group of adults needs further engagement with physicians and health care systems to support ongoing tracking and management of their blood pressure.

“It’s not just that they are impacted, it’s that they may not be part of the health care system. They might not have a usual source of care or insurance or have seen a provider,” said Wozniak. “The recommendation is that an individual is supposed to get this lifestyle modification, but they don’t have accessibility to it because if you don’t have insurance, you’re likely to not be in the system.”

Establishing linkages to health care is also needed to improve their referral to and use of lifestyle modification interventions, such as the dietary approaches to stop hypertension (DASH) eating plan, lowering body weight and raising physical activity levels. 

Men. Overall reclassification of hypertension was greater in men (47 percent) than women (42 percent). For recommended pharmacologic treatment, men also saw a rise compared to women. 

The biggest change in reclassification was seen in the recommendation for lifestyle modification alone. For elevated BP or stage one hypertension, men saw a 26.2 percent increase in recommendation of lifestyle modification compared to women (16.9 percent).  

Young adults to middle aged. The guideline disproportionately affects some groups more than others. This includes adults between 18 and 64 years old—one group that historically has had limited access to or low use of health care services for hypertension management.

However, a significant rise was seen in the middle-aged population. While reclassification of hypertension increased for this age group, it fell among seniors. These age groups also saw an increase in recommendations for pharmacologic treatment and lifestyle modification, compared with adults between 18 and 44 years old.

Overweight. Seventy-two percent of the U.S. adults with newly recommended lifestyle modification are overweight or obese.

The U.S. Preventive Services Task Force recommends that health professionals offer or refer obese or overweight patients with additional cardiovascular disease risk factors to intensive, multicomponent behavioral interventions.