Uncontrolled hypertension by the 2014 evidence-based guideline: results from NHANES 2011-2012.

Abstract

To look at the prevalence of uncontrolled hypertension in the population using various hypertension guidelines [Seventh Joint National Committee (JNC 7), European Society of Hypertension (ESH)/European Society of Cardiology (ESC) and Canadian Hypertension Education Program (CHEP)] and to assess the predictors of being reclassified to controlled hypertension based on the 2014 evidence-based guideline (2014 EBG) in comparison to JNC 7. Using the National Health and Nutrition Examination Survey for 2011-2012, the prevalence of uncontrolled hypertension in the population was ascertained using different guidelines, including 2014 EBG, JNC 7, ESH/ESC and CHEP. Prevalence of uncontrolled hypertension was further examined based on subgroups by age, sex, race and presence of chronic kidney disease or diabetes. Predictors to be reclassified to controlled hypertension by the 2014 EBG were assessed using multivariable logistic regression. Prevalence of uncontrolled hypertension was 12.8% by the 2014 EBG in comparison to 16.6% by JNC 7, 13.6% by ESH/ESC and 15.6% by CHEP (P < 0.001). As per JNC 7, 23.0% of those with uncontrolled hypertension were reclassified to controlled hypertension by the 2014 EBG. Those most likely to be reclassified to controlled hypertension were older, females and those with diabetes. On the basis of the updated 2014 evidence-based high blood pressure guideline, the percentage of the US population labeled as suffering from uncontrolled hypertension has changed from 16.6 to 12.8%. It is important to note that this change is a reflection of the modified blood pressure targets and not a change in the actual levels of blood pressure control in the population. The greatest impact of reclassification is on elderly, females and those with diabetes.