Implications of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline in a Modern Primary Prevention Multi-Ethnic Prospective Cohort (Multi-Ethnic Study of Atherosclerosis)

Abstract

The American College of Physicians and the American Academy of Family Physician did not endorse the 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines citing multiple concerns. We assessed the increase in antihypertensive medication eligibility introduced by the 2017 hypertension guideline and the risk profile of those newly eligible for blood pressure medication using participants from the MultiEthnic Study of Atherosclerosis. The antihypertensive medication eligibility criteria of the Joint National Commission (JNC) VII, JNC VIII, and the 2017 ACC/AHA hypertension guidelines were applied to the cohort and the risk profile of those newly eligible was compared with those ineligible for antihypertensive medication under the 2017 ACC/AHA guidelines using Kaplan-Meier and Cox proportional hazard analysis. The new guideline increased antihypertensive medication eligibility by 46.8% and 96.7% compared with the JNC VII and JNC VIII guideline respectively. The newly eligible group did not have an increased risk of incident atherosclerotic cardiovascular disease, heart failure, or death compared with those ineligible (HR [95%CI]: 1.26 [0.96 to 1.65], p = 0.10; 0.75 [0.45 to 1.26], p = 0.27; 1.06 [-0.84 to 1.36], p = 0.62, respectively) after adjusting for age, gender, and race. The 2017 ACC/AHA hypertension guidelines extend antihypertensive medication to a substantial number of individuals, although the risk profile of the newly eligible group appears similar to those ineligible for antihypertensive medication after adjusting for non-modifiable risk factors.