Estimated Impact of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines on Reproductive-Aged Women

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults lowered the threshold of hypertension compared to the American College of Obstetricians and Gynecologists (ACOG) guidelines used to define hypertensive disorders of pregnancy. We sought to describe the impact of reclassifying hypertension for reproductive-aged women in the United States using the 2017 ACC/AHA guidelines. We analyzed data from a cohort of women 20–44 years of age from the 2011–2014 National Health and Nutrition Examination Survey (n=2311), and sampling weights were used to obtain nationally-representative hypertension prevalence estimates. Additional analyses were performed on subgroups of low-risk women (n=2110) and those currently or previously pregnant (n=1298). The prevalence of hypertension by ACOG and 2017 ACC/AHA guidelines was 10.2% (95% CI, 8.7%−11.6%) and 18.9% (95% CI, 16.8%−21.1%), respectively. Results were similar in a cohort of low-risk women were currently or previously pregnant. This study suggests that adoption of ACC/AHA guidelines for hypertension would increase the number of reproductive-aged women with hypertension by approximately two-fold. Further studies are needed to determine the safety and efficacy of lower blood pressure targets, as well as the potential impact on risk assessment and obstetric care, in this specialized population. SUMMARY: Approximately twice as many women of reproductive age will have a diagnosis of hypertension by 2017 ACC/AHA guidelines compared to ACOG guidelines.