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April 16, 2014
More Than 5 Million Could Be Off BP Meds Under
New Guidelines Durham, NC—Will the local pharmacy be a little less busy if physicians follow new guidelines for controlling blood pressure? Possibly, based on a new study that says the guidelines, announced in February by the Eighth Joint National Committee, could result in 5.8 million U.S. adults no longer requiring hypertension medication. The analysis by researchers from Duke University in Durham, North Carolina, and McGill University in Montreal was published online recently by the Journal of the American Medical Association, coinciding with the American College of Cardiology meeting in Washington, D.C. The committee, convened by the National Heart, Lung and Blood Institute, relaxed the blood pressure goal in adults 60 years and older to 150/90, instead of the previous goal of 140/90, established just more than a decade ago, and also recommended more flexibility for patients with diabetes and kidney disease. “Raising the target in older adults is controversial, and not all experts agree with this new recommendation,” said lead author Ann Marie Navar-Boggan, MD, PhD, a cardiology fellow at Duke University School of Medicine. “In this study, we wanted to determine the number of adults affected by these changes.” For the study, researchers used 2005-2010 data from the National Health and Nutrition Examination Survey (NHANES) conducted by the CDC. Based on the study sample of more than 16,000 participants with blood pressure measurements, the researchers determined that the proportion of U.S. adults considered eligible for hypertension treatment would decrease from 40.6% under the old guidelines to 31.7% under the new recommendations. Another 13.5 million adults, most of them over the age of 60, would move from the category of “poorly controlled” blood pressure based on the standards of the seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) to “adequately managed” under the new guidelines. Study results indicate that the proportion of younger adults (18-59 years) with treatment-eligible hypertension under the previous guideline was 20.3% and decreased to 19.2% under the 2014 recommendations. Greater declines were observed among older adults 60 and older, dropping from 68.9% to 61.2%. “The proportion of adults with treatment-eligible hypertension who met BP goals increased slightly for younger adults, from 41.2% (95% CI, 38.1%-44.3%) under JNC 7 to 47.5% (95% CI, 44.4%-50.6%) under the 2014 BP guideline, and more substantially for older adults, from 40.0% (95% CI, 37.8%-42.3%) under JNC 7 to 65.8% (95% CI, 63.7%-67.9%) under the 2014 BP guideline,” the authors report. Overall, the study points out, 1.6% of U.S. adults aged 18-59 years and 27.6% of adults aged 60 years or older were receiving BP-lowering medication based on the tighter JNC 7 targets. “These patients may be eligible for less stringent or no BP therapy with the 2014 BP guideline,” the authors explain. If physicians follow the new guidelines closely, that would take 5.8 million U.S. adults off of blood pressure medication. “This study reinforces how many Americans with hypertension fall into the treatment ‘gray zone’ where we don’t know how aggressive to treat and where we urgently need to conduct more research” pointed out Eric D. Peterson, MD, a Duke professor of medicine. “The new guidelines do not address whether these adults should still be considered as having hypertension,” Navar-Boggan added. “But they would no longer need medication to lower their blood pressure.” “These adults would be eligible for less intensive blood pressure medication under the new guidelines, particularly if they were experiencing side effects,” she continued. “But many experts fear that increasing blood pressure levels in these adults could be harmful.” Navar-Boggan said that, even under the newer, less stringent guidelines, an estimated 28 million U.S. adults with hypertension still have uncontrolled blood pressure, and more than half of them remain untreated.
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