Key result
The prevalence of apparent treatment-resistant hypertension was higher using the 2017 ACC/AHA guideline compared to the JNC 7 guideline (21.8% vs 16.9%; difference 4.9%, 95% CI 4.7-5.1%).
Why the study?
The study was conducted to compare the prevalence of apparent treatment-resistant hypertension according to JNC 7 versus the 2017 ACC/AHA guideline in an integrated healthcare delivery system.
How does the prevalence of apparent treatment-resistant hypertension differ when applying the 2017 ACC/AHA guidelines compared to the JNC 7 guidelines in adults with treated hypertension?
Cross-Sectional (n=469,509)
How does the prevalence of apparent treatment-resistant hypertension differ when applying the 2017 ACC/AHA guidelines compared to the JNC 7 guidelines in adults with treated hypertension?
Effect estimate: Δ 4.9% (95% CI 4.7-5.1)
Absolute Event Rate: 21.8% vs 16.9%
Applying the more stringent 2017 ACC/AHA blood pressure guidelines significantly increases the prevalence of apparent treatment-resistant hypertension compared to JNC 7 criteria, highlighting a large population with suboptimal use of recommended therapies.
Alerts clinicians to higher aTRH identification under 2017 criteria; leaves open outcome impact in real-world cohorts.
OBJECTIVES: We compared the prevalence of apparent treatment-resistant hypertension (aTRH) according to the seventh report of the Joint National Committee (JNC 7) and the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline in an integrated healthcare delivery system. METHODS: We identified individuals aged at least 18 years with hypertension from Kaiser Permanente Southern California between 1 July 2014 and 30 June 2015. aTRH was defined as either blood pressure (BP) above goal (≥140/90 mmHg per JNC7, and ≥130/80 mmHg per 2017 ACC/AHA for most adults with hypertension) while taking at least 3 classes of antihypertensive medication or taking at least four classes regardless of BP level. A secondary analysis was conducted requiring use of a diuretic for the definition of aTRH. Patient clinical characteristics and antihypertensive medication use were described using electronic health records. RESULTS: We included 469 509 patients with treated hypertension [mean (SD) age 65 years (12), 46% white, 26% Hispanic, 13% black, and 12% Asian]. The prevalence of aTRH was 16.9 and 21.8% according to the JNC 7 and the 2017 ACC/AHA guidelines, respectively [Δ = 4.9% (95% CI: 4.7--5.1%)]. By requiring a diuretic to be considered as aTRH, the prevalence of aTRH decreased to 13.4 and 17.2% according to the JNC 7 and the 2017 ACC/AHA guidelines, respectively. Among patients with aTRH, 1.9% received a long-acting thiazide-like diuretic, and 5.6% received a mineralocorticoid receptor blocker. CONCLUSION: The prevalence of aTRH increased using the more stringent BP goals of the 2017 ACC/AHA guideline. The use of recommended therapy for aTRH was suboptimal suggesting a potential area for improvement.
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An et al. (2020) conducted a cross-sectional in Treated hypertension (n=469,509). 2017 ACC/AHA guideline definition of aTRH vs. JNC 7 guideline definition of aTRH was evaluated on Prevalence of apparent treatment-resistant hypertension (aTRH) (Δ 4.9%, 95% CI 4.7-5.1). The prevalence of apparent treatment-resistant hypertension was higher using the 2017 ACC/AHA guideline compared to the JNC 7 guideline (21.8% vs 16.9%; difference 4.9%, 95% CI 4.7-5.1%).
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