Abstract P177: Hypertension is Considerably More Prevalent, Yet Decreasing Over Time According to the New Guidelines

Abstract

Introduction: New High Blood Pressure (BP) Guidelines released by the American Heart Association (AHA) and the American College of Cardiology redefined hypertension, imparting implications for monitoring cardiovascular health (CVH). The impact on reclassification of patients according to electronic health record (EHR) data as a result of changes in criteria for BP cut points has not yet been described. Hypothesis: We hypothesized that more stringent cut points for hypertension would increase the prevalence of United States (US) adults with poor CVH for BP. Methods: We analyzed outpatient visit data recorded in The Guideline Advantage©, a repository of EHRs of patients from eight diverse healthcare systems in the US from 2012-2015. For each year, the first non-missing BP measurement for each patient was categorized into poor (hypertensive), intermediate (pre-hypertensive), and ideal (normotensive) for CVH, first in accordance with AHA’s Life Simple 7 guidelines, and then in accordance with the new guidelines. We compared overall trends with trends stratified by race and sex, in distributions of poor and intermediate categories, and in the proportion eligible for pharmacological treatment (BP ≥ 130/80). Results: A total of 172,209 unique patients contributed 348,933 BP measurements, and most were female (58.63%) and white (75.09%). Although the prevalence of poor CVH for BP was consistently 3-fold higher under the new guidelines and the difference in prevalence was significant (p<0.0001), it decreased over time for the both the old (9.4% to 8.7%) and new (27.8% to 26.4%) guidelines. Over time, the proportion classified as hypertensive decreased (12.4% to 10.4 vs. 33.9% to 30.3%) for males and increased for non-whites (10.2% to 13.9% vs. 27.1% to 35.3%) from the old and new guidelines, respectively, but remained stable for females and whites. Similarly, the annual difference in the proportion of intermediate CVH for BP was significant (p<0.0001); however, pre-hypertension prevalence slightly increased under the old (57.9% to 58.5%) and new (39.5% to 40.7%) guidelines. Among untreated adults eligible for pharmacological intervention, the proportion remained relatively unchanged over time; in 2015, patients lacking treatment yet meeting treatment criteria was 23% and 7.3% under the new and old guidelines, respectively, resulting in a difference of 15.7% (p<0.0001). Whites (66.8%) and females (50.6%), compared with non-whites and males, respectively, comprised the majority. Conclusions: Prevalence of poor CVH for BP among US adults substantially increases in the outpatient setting when categorizing measures with the new guidelines. Active participation by clinicians and public health practitioners are needed to address the higher prevalence of and disparities in both hypertension and treatment prescription identified with the old versus new guidelines.