Abstract P177: Projected Change in Outpatient Management of Blood Pressure in the United States with the Implementation Of JNC-8 as Compared to JNC-7 Criteria
Background: The 2014 Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) hypertension management guidelines support less restrictive blood pressure (BP) criteria among patients with age ≥ 60, diabetes or chronic kidney disease than the 2007 recommendations (JNC-7). We compared the proportion of patients for whom treatment escalation is recommended according to the JNC-8 guidelines vs. JNC-7.
Methods and Results: We analyzed the National Ambulatory Medical Care Survey 2008-2010 dataset of about 76,000 US adult (>18 years old) outpatient visits representing 820 million annual outpatient visits. A clinical history of hypertension was present in 33.3%, and BP was recorded at 67.1% of all visits. Of these, 41.7% clinic visits involved patients ≥60 years old, and 15.5% included those with diabetes or non-diabetic renal disease. We restricted further analysis to those with measured blood pressure.
Among patients without a prior diagnosis of hypertension, BP management should be initiated for 6% fewer patients (13.4% vs. 19.4%, p<0.001) for the JNC-8 guidelines than JNC-7 criteria, respectively. In those with a prior diagnosis of hypertension, BP treatment escalation was needed in 17.7% fewer patients (28.8% vs. 46.5%, p<0.001) for the JNC-8 than JNC-7 criteria. The difference of overall patients needing either treatment initiation or escalation was obviously more apparent among those ≥ age 60 years with 23.4% lesser patients (21.8 vs. 45.2%, p<0.001) as well as those with renal disease or diabetes with 31.3% lesser patients (27.1 vs. 58.4% p<0.001).
Conclusions: In this U.S. representative sample of outpatient visits, implementation of the JNC-8 hypertension guidelines decreases the need for initiation or intensification of anti-hypertensive treatment in about one out of six outpatients visits than JNC-7 guidelines. Thus, such shifts may influence treatment decisions for more than 100 million outpatient encounters annually. The actual implementation and associated change in patient outcomes need to be studied.
Author Disclosures: S.K. Agarwal: None. I. Sherifi: None. N. Tripathi: None. J. Halperin: None.
- © 2016 by American Heart Association, Inc.