High Blood Pressure Guidelines Research Articles

Racial and Ethnic Disparities in Antihypertensive Medication Prescribing Patterns and Effectiveness.

Variability in drug effectiveness and provider prescribing patterns have been reported in different racial and ethnic populations. We sought to evaluate antihypertensive drug effectiveness and prescribing patterns among self-identified Hispanic/Latino (Hispanic), Non-Hispanic Black (Black), and Non-Hispanic White (White)populations that enrolled in the NIH All of Us Research Program, a US longitudinal cohort. We employed a self-controlled case study method using electronic health record and survey data from 17,718 White, Hispanic, and Black participants who were diagnosed with essential hypertension and prescribed at least one of 19 commonly used antihypertensive medications. Effectiveness was determined by calculating the reduction in systolic blood pressure measurements after 28 or more days of drug exposure. Starting systolic blood pressure and effectiveness for each medication were compared for self-reported Black, Hispanic, and White participants using adjusted linear regressions. Black and Hispanic participants were started on antihypertensive medications at significantly higher SBP than White participants in 13 and 7 out of 19 medications, respectively. More Black participants were prescribed multiple antihypertensive medications (58.46%) than White (52.35%) or Hispanic (49.9%) participants. First-line HTN medications differed by race and ethnicity. Following the 2017 American College of Cardiology and the American Heart Association High Blood Pressure Guideline release, around 64% of Black participants were prescribed a recommended first-line antihypertensive drug compared with 76% of White and 82% of Hispanic participants. Effect sizes suggested that most antihypertensive drugs were less effective in Hispanic and Black, compared with White, participants, and statistical significance was reached in 6 out of 19 drugs. These results indicate that Black and Hispanic populations may benefit from earlier intervention and screening and highlight the potential benefits of personalizing first-line medications.

Current Trends in Hypertension Identification and Management: Insights from the National Health and Nutrition Examination Survey (NHANES) Following the 2017 ACC/AHA High Blood Pressure Guidelines.

Hypertension is a global health issue associated with increased cardiovascular morbidity and mortality. This study aimed to investigate contemporary hypertension identification and management trends following the 2017 American College of Cardiology/American Heart Association guidelines. Data from the National Health and Nutrition Examination Survey conducted from 2017 to 2020 were analyzed. Participants between 20 and 79 years of age were included. Participants were stratified into different treatment groups based on indication and guideline adherence. Descriptive statistics were used to compare medication use, diagnosis rates, and blood pressure control. A total of 265 402 026 people met the inclusion criteria, of which 19.0% (n=50 349 209) were undergoing guideline antihypertensive management. In the guideline antihypertensive management group, a single antihypertensive class was used to treat 45.7% of participants, and 55.2% had uncontrolled blood pressure. Participants not undergoing guideline antihypertensive management qualified for primary prevention in 11.5% (n=24 741 999) of cases and for secondary prevention in 2.4% (n=5 070 044) of cases; of these, 66.3% (n=19 774 007) did not know they may have hypertension and were not on antihypertensive medication. Adherence to guidelines for antihypertensive management is suboptimal. Over half of patients undergoing guidelinetreatment had uncontrolled blood pressure. One-third of qualifying participants may not be receiving treatment. Education and medical management were missing for 2 in 3 qualifying participants. Addressing these deficiencies is crucial for improving blood pressure control and reducing cardiovascular event outcomes.

Prevalence of Self-Reported Hypertension and Antihypertensive Medication Use Among Adults - United States, 2017-2021.

Hypertension, or high blood pressure, is a major risk factor for heart disease and stroke. It increases with age and is highest among non-Hispanic Black or African American persons, men, persons aged ≥65 years, those of lower socioeconomic status, and those who live in the southern United States. Hypertension affects approximately one half of U.S. adults, and approximately one quarter of those persons have their blood pressure under control. Reducing population-level hypertension prevalence and improving control is a national priority. In 2017, updated guidelines for high blood pressure in adults recommended lowering the blood pressure threshold for diagnosis of hypertension. Analysis of data from the Behavioral Risk Factor Surveillance System found that age-standardized, self-reported diagnosed hypertension was approximately 30% during 2017-2021, with persistent differences by age, sex, race and ethnicity, level of education, and state of residence. During this period, the age-standardized prevalence of antihypertensive medication use among persons with hypertension increased by 3.1 percentage points, from 59.8% to 62.9% (p<0.001). Increases in antihypertensive medication use were observed in most sociodemographic groups and in many states. Assessing current trends in hypertension diagnosis and treatment can help guide the development of policies and implementation of interventions to reduce this important risk factor for cardiovascular disease and can aid in addressing health disparities.

Abstract 15517: Physician-Patient Engagement to Improve Ambulatory Systolic Blood Pressure

Introduction: Hypertension is a leading cause of death and disability-adjusted life-years globally. Using implementation science of the 2017 ACC/AHA Guideline for High Blood Pressure (BP) in Adults, we posited a quality improvement (QI) project targeting physician education and multidisciplinary patient engagement in two large urban ambulatory clinics to improve patient blood pressures. Hypothesis: We hypothesize that direct physician and patient education and engagement improves achievement of hypertension goals within ambulatory clinics. Methods: A QI initiative consisting of a half-day of resident hypertension education, patient access to home BP monitors, and direct patient engagement via physician outreach was conducted. Patients not at BP goal defined as systolic blood pressure (SBP) &gt;130 mmHg were followed over 8 months via multidisciplinary approach to ensure adequate follow-up appointments. Data was collected after 8-months and compared descriptively. BP ranges at month 0: Group A &lt;130 mmHg, Group B 130-139 mmHg, Group C 140-159 mmHg, Group D &gt;=160 mmHg. Emphasis was placed on Groups C and D. Results: A total of 6,030 patients had follow-up visits in the 8-month study window. At month 0, 874 patients fell within Group C and 301 within Group D. Of those in Group C, 29.5% achieved SBP goal (&lt;130 mmHg), 27.5% improved BP to 130-139 mmHg, and 34.4% remained within 140-159 mmHg at month 8. In Group D, 20.9% achieved goal SBP &lt;130 mmHg, 17.6% reached 130-139 mmHg, and 34.6% improved to 140-159 mmHg. (Figure 1). Limitations included patients without access to BP cuff during telehealth visits. Conclusions: Direct physician engagement and multidisciplinary approach to hypertension management led to decreased SBP readings. Further investigation is warranted to determine how these interventions affect long-term cardiovascular outcomes.

Abstract 18388: Hypertension Identification and Management in the USA: Adherence of the 2017 ACC/AHA High Blood Pressure Guidelines

Background: The 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults changed the criteria for a diagnosis of hypertension and provided new recommendations goals and management. We aimed to investigate the prevalence of hypertension identification, treatment, and adherence in the US population. Methods: We analyzed the 2017-2020 pre-pandemic National Health and Nutrition Examination Survey for participants between 18 and 79 years of age. Participant data was used to assess for a hypertension diagnosis and eligibility for AHA/ACC’s primary or secondary prevention hypertension strategies. Current hypertension medication usage was stratified if prescribed for hypertension management or a non-hypertension indication. Participants with a current hypertension-indicated medication were identified as “Undergoing Treatment”; all other participants were stratified into “No Indication”, “Primary Prevention”, or “Secondary Prevention”, based on the AHA/ACC guideline. Complex survey methodology with weighting was utilized for national estimates. Results: Our study included 236,621,712 participants, of which 22.4% (n=53,064,773) were undergoing treatment for hypertension, 67.0% (n=158,613,605) had no indication for management, 8.9% (n=21,158,544) qualified for primary prevention, and 1.6% (n=3,784,790) qualified for secondary prevention. A known hypertension diagnosis was reported in 26.0% of the primary prevention group, 45.0% of secondary prevention, and 94.8% of those undergoing treatment. In patients undergoing treatment, 57.9% of participants had mean blood pressure readings above goal. Conclusion: One in ten adults under 80 qualify for hypertension management but may not be undergoing treatment. Of patients qualifying without current treatment, most did not know they would qualify for a hypertension diagnosis. More than half of treated patients did not meet blood pressure goals.

Improved Compliance of Pediatrics High Blood Pressure Guidelines in Well-Child Clinic Visits.

The providers were educated on American Academy of Pediatrics high BP clinical practice guidelines. We integrated the guideline steps into the electronic medical record (EMR) and analyzed outcome measures. The outcome measures were: (1) BP recorded in the chart, (2) screening done by simplified BP table by clinic staff, (3) repeat manual BP by the provider, (4) BP classification, (5) documentation of BP classification, (6) management plan, and (7) follow-up schedule. Specific interventions were made based on each plan-do-study-act (PDSA) cycle, including reeducating the guidelines, reemphasizing following the EMR steps, and providing providers with individualized feedback and alerts. Six of 7 outcome measures (except repeat manual BP by provider) achieved 86%-100% range after the second PDSA cycle. The annotated run chart demonstrates that repeat manual BP by provider improved from 38% to 89% in the fourth PDSA cycle. Pediatric residents who run well-child clinics improved adherence to pediatric high BP guidelines by providing education and integrating prompts and information into the EMR.

PHYSICAL AND BIOCHEMICAL RISK FACTORS OF HYPERTENSION: FINDINGS FROM MULTI-SITED POPULATION-BASED STUDY FROM INDIA

Objective: Studies have shown variations in the degree of association between hypertension and its risk factors in different populations. Both genetic and environmental factors are thought to play roles in modulating the relationship between hypertension and its physical and biochemical risk factors/markers. The present study aims to investigate the association of hypertension with body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low-density density lipoprotein (VLDL), and apolipoprotein B (Apo B) in three tribal (Liangmai, Mizo, and Bhil) and two non-tribal (Jat and Meitei) populations of India. Design and method: The present study is an outcome of four cross-sectional studies undertaken among three tribal, Liangmai (n = 339), Mizo (n = 269) and Bhil (n = 407), and two non-tribal, Jat (n = 1447) and Meitei (n = 1142), populations of India (total sample size = 3604). Recruited participants were adults (age range 18-86 years; mean age = 47.3±11.0 years) of both sexes (55.5% females). Socio-demographic data was collected using a pretested and modified interview schedule. Height, weight, waist and hip circumference, and hypertension were measured using standard techniques. Hypertension was defined as per ACC/AHA High Blood Pressure Guidelines. Values of TC, TG, and HDL levels were obtained using commercial kits (Randox, USA) through spectrophotometry. Values of LDL, VLDL, and Apo B were calculated. Statistical analysis was performed using SPSS version 22. Results: The overall prevalence of hypertension stage-1 and stage-2 was found to be 37.9% and 34.0%, respectively. The highest prevalence of hypertension (stage-1+sage-2) was found in Meitei community and the lowest in the Bhil community. Studied physical and biochemical risk factors showed variations in the degree of association with hypertension in different populations. Of the studied risk factors, BMI and WC showed most consistent and statistically significant positive association with systolic and diastolic blood pressure. Though hypertension was found to be associated with some of the lipid variables in some populations, the pattern was not consistent across populations. Conclusions: The study suggests that physical variables (BMI and WC) may be better markers of hypertension than biochemical variables.

Comparison of Demographic Factors and Personal Lifestyle Characteristics with 2020 ISH Guidelines for High Normal Blood Pressure in Relation to Absence and Presence of ECG Diagnosed LVH in Healthy Adults: A Cross-sectional Study

Introduction: Early identification of Left Ventricular Hypertrophy (LVH), a powerful and independent predictor of Cardiovascular Disease (CVD), is a key element for preventing Cardiovascular Events (CVE). High-Normal Blood Pressure (HNBP) was significantly associated with a new-onset Electrocardiogram (ECG) diagnosed LVH. The demographic and personal lifestyle characteristics could be related to HNBP in ECG diagnosed LVH. This relation, if found, can be useful as a factor for early identification of HNBP in relation to ECG diagnosed LVH. Aim: To compare demographic and personal lifestyle characteristics with HNBP in relation to ECG diagnosed LVH in healthy adults. Materials and Methods: The cross-sectional study was conducted in AIIMS Raipur (CG) from April 2021 to March 2022 among 95 healthy adult males between 20 to 39 years with a Blood Pressure (BP) of 130-139/85-89 mm Hg and no antihypertensive medications. Permission was obtained from the Ethics committee of AIIMS Raipur (CG). Data was collected from the individuals using health questionnaire, Personal Lifestyle Questionnaire (PLQ), validated anthropometric equipment stature meter for measuring height and weighing machine, a working electronic BP measuring instrument, and ECG. The present study included demographic factors like age, height, weight, Body Mass Index (BMI), educational level, marital status, occupation, and Socio-Economic Status (SES) classified based on Kuppuswamy’s classification. The personal lifestyle characteristics included physical activity, use of substances (alcohol, smoking, tobacco, gutkha), and diet. The unpaired t-test, Chi-square test and regression analysis were applied for the analysis of the collected data. Results: Representation of demographic factors were age (31.9±5.08), height (1.69±0.06), weight (68.3±10.2), BMI (23.8±3.05) in terms of (mean±SD) and SES in terms of n (%) were upper I-7 (7.4), upper middle II-31 (32.6), lower middle III-30 (31.6), upper lower IV-25 (26.3), lower V-2 (2.1). SES classes of modified Kuppuswamy’s SES scale had a significant relationship with LVH {p-value &lt;0.05 (0.003)}. All LVH (+) individuals were from the lower middle III SES class {7 (7.4%)}. Daily use of substances (alcohol, smoking, tobacco, gutkha) had a significant association with LVH {p-value &lt;0.05 (0.005)}. Group-IV (35- 39 years) (standard coefficient 0.4621059, 95%CI-0.0385065 to 0.4686115; p-value-0.021) had more positive relation than Group-II (25-29 years) (std. coef. 0.4422758, 95%CI-0.0501719 to 0.4566986; p-value-0.015). Primary Educational level (std. coef.-0.2473403, 95%CI-0.8019454 to-0.0982954; p-value0.013) had a negative relation with SL-LVH (p&lt;0.05). Conclusion: The study concluded that lower middle III class SES and daily use of substances (alcohol, smoking, tobacco, gutkha), age Group-IV (35-39 years), and primary educational level were the predicted demographic and lifestyle characteristics of HNBP in relation to ECG diagnosed LVH.

Real-World Incidence and Management of Ibrutinib-Induced Hypertension in Patients with Chronic Lymphocytic Leukemia

Background: Clinical trials demonstrated that ibrutinib improves progression-free and overall survival in patients with chronic lymphocytic leukemia (CLL). After widespread use of ibrutinib in clinical practice, the incidence of ibrutinib-induced hypertension (HTN) has been more frequent than reported in the clinical trials, with an incidence between 35% and 72%. No guidelines exist for the management of ibrutinib-induced HTN. Methods: A single-center, retrospective cohort study was conducted in patients with CLL initiated on ibrutinib from April 2014 to May 2020. We identified patients at least 18 years old, prescribed ibrutinib for CLL at UNC Medical Center and affiliated centers, alive and not transitioned to hospice or discontinued from ibrutinib within two months of initiation. Patients were excluded if they had blood pressure (BP) measurements documented at less than 3 visits within 24 weeks of initiating ibrutinib. Co-primary study outcomes were overall incidence and severity of HTN within 24 weeks of ibrutinib initiation. Secondary study outcomes include change in systolic BP (SBP) and diastolic BP (DBP), and the probability of increasing the antihypertensive intensity (e.g., new agent or increased dose) adjusted for mean SBP. Incidence of HTN, including new onset (defined by ACC/AHA 2017 Guideline for High Blood Pressure in Adults) or worsening HTN (defined by change in version 5 of Common Terminology Criteria for Adverse Events [CTCAE v5.0] grade), was assessed by descriptive statistics. A linear mixed effects regression model, with random intercepts for patients, estimated mean SBP and DBP measurements at weeks 0, 4, 8, 12, 16, 20, and 24. A logistic mixed effects model was used to estimate the probability of antihypertensive therapy intensification, adjusting for SBP. Results: Among 37 patients (mean age 67.3 ± 10.6 years, 87% Caucasian, 65% male), mean baseline SBP and DBP were 134.0 ± 17.9 mmHg and 70.5 ± 9.87 mmHg, respectively, and 73% were on at least one antihypertensive agent prior to ibrutinib initiation. The prevalence of HTN at baseline was 54% (Stage 2, 38%). Over 24 weeks, the incidence of new onset HTN was 69% (Stage 2, 33%) and worsening HTN was 68% (Stage 2, 92%). At 24 weeks, 29% of BPs were defined as Grade 3 per CTCAE v5.0. Over 24 weeks, mean SBP increased 9.7 mmHg (95% CI 2.20, 16.50) and mean DBP increased 5.9-mmHg (95% CI 1.03, 9.13). On average, patients who had a SBP measurement less than 165 mmHg had a less than 5% chance of antihypertensive intensification. The chance of intensification for patients with a SBP measurement of 165-210 mmHg increased up to 15%. Conclusions: Following initiation of ibrutinib in CLL patients, the incidence of new onset and worsening HTN was higher than previously described. Over 24 weeks, a clinically meaningful increase in BP occurred. Regardless of BP severity, antihypertensive intensification was minimal.

Quality measures for the care of adult patients with obstructive sleep apnea: 2022 update after measure maintenance.

Lloyd R, Morgenthaler TI, Donald R, etal. Quality measures for the care of adult patients with obstructive sleep apnea: 2022 update after measure maintenance. J Clin Sleep Med. 2022;18(11):2673-2680.

Self-Reported Antihypertensive Medication Class and Temporal Relationship to Treatment Guidelines.

The greater antihypertensive responses to initial therapy with calcium channel blockers (CCBs) or thiazide-type diuretics than renin-angiotensin system blockers as initial therapy in non-Hispanic Black (NHB) adults was recognized in the US High BP guidelines from 1988 to 2003. The 2014 Report from Panel Members Appointed to the Eighth Joint National Committee (2014 aJNC8 Report) and the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline were the first to recommend CCBs or thiazide-type diuretics rather than renin-angiotensin system blockers as initial therapy in NHB. We assessed the temporal relationship of these recommendations on self-reported CCB or thiazide-type diuretics monotherapy by NHB and NHW adults with hypertension absent compelling indications for β-blockers or renin-angiotensin system blockers in National Health and Nutrition Examination Surveys 2015 to 2018 versus 2007 to 2012 (after versus before 2014 aJNC8 Report). CCB or thiazide-type diuretics monotherapy was unchanged in NHW adults (17.1% versus 18.1%, P=0.711) and insignificantly higher after 2014 among NHB adults (43.7% versus 38.2%, P=0.204), although CCB monotherapy increased (29.5% versus 21.0%, P=0.021) and renin-angiotensin system blocker monotherapy fell (44.5% versus 31.0%, P=0.008). Although evidence-based CCB monotherapy increased among NHB adults in 2015 to 2018, hypertension control declined as untreated hypertension and monotherapy increased. While a gap between recommended and actual monotherapy persists, evidence-based monotherapy appears insufficient to improve hypertension control in NHB adults, especially given evidence for worsening therapeutic inertia. Initiating treatment with single-pill combinations and timely therapeutic intensification when required to control hypertension are evidence-based, race-neutral options for improving hypertension control among NHB adults.

Pediatrician Adherence to Guidelines for Diagnosis and Management of High Blood Pressure

To assess pediatrician adherence to the 2017 American Academy of Pediatrics' clinical practice guideline for high blood pressure (BP). Pediatric primary care practices (n=59) participating in a quality improvement collaborative submitted data for patients with high BP measured between November 2018 and January 2019. Baseline data included patient demographics, BP, body mass index (BMI), and actions taken. Logistic regression was used to test associations between patient BP level and BMI with provider adherence to guidelines (BP measurement, counseling, follow-up, evaluation). A total of 2677 patient charts were entered for analysis. Only 2% of patients had all BP measurement steps completed correctly, with fewer undergoing 3-limb and ambulatory BP measurement. Overall, 46% of patients received appropriate weight, nutrition, and lifestyle counseling. Follow-up for high BP was recommended or scheduled in 10% of encounters, and scheduled at the appropriate interval in 5%. For patients presenting with their third high BP measurement, 10% had an appropriate diagnosis documented, 2% had appropriate screening laboratory tests conducted, and none had a renal ultrasound performed. BMI was independently associated with increased odds of counseling, but higher BP was associated with lower odds of counseling. Higher BP was independently associated with an increased likelihood of documentation of hypertension. In this multisite study, adherence to the 2017 American Academy of Pediatrics' guideline for high BP was low. Given the long-term health implications of high BP in childhood, it is important to improve primary care provider recognition and management. ClinicalTrials.gov: NCT03783650.

Different hypertension thresholds and cognitive decline: a pooled analysis of three ageing cohorts

BackgroundThe 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for high blood pressure (BP) in adults came up with a new definition of hypertension with a threshold BP level of 130/80 mmHg. But the 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guidelines adhered to a conventional hypertension definition as BP ≥ 140/90 mmHg. We aimed to compare the trajectories of cognitive decline between participants with BP < 130/80 mmHg in all BP measurement waves and others with all BP < 140/90 mmHg.MethodsThis pooled analysis involved middle-aged and older participants from three nationally representative ageing cohorts, including the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), and the China Health Retirement Longitudinal Study (CHARLS). Participants were divided into the Normal (BP < 130/80 mmHg on all occasions throughout the study), the Borderline (BP < 140/90 mmHg on all occasions throughout the study but not in the Normal group), and the High (the rest of participants) BP groups. Global cognitive Z score was calculated from tests on memory, executive function, and orientation.ResultsA total of 17,590 participants (HRS 6964, median follow-ups 12 years; ELSA 5334, median follow-ups 16 years; CHARLS 5292, median follow-ups 7 years) were included. No significant difference in global cognitive decline rate was detected between the Normal and the borderline groups (men, pooled β = − 0.006 standard deviation [SD]/year; 95% confidence interval [CI], − 0.020 to 0.008; P = 0.377; women, pooled β = 0.006 SD/year; 95% CI − 0.005 to 0.018; P = 0.269). Participants in the High group had a significantly faster cognitive decline (men, pooled β = − 0.011 SD/year; 95% CI − 0.020 to − 0.002; P = 0.013; women, pooled β = − 0.017 SD/year; 95% CI − 0.026 to − 0.008; P < 0.001) than that in the Borderline group.ConclusionsIndividuals in the Borderline group did not experience significantly faster cognitive decline compared with those in the Normal group. It might not be necessary for individuals with borderline BP (between 130/80 and 140/90 mmHg) to initiate antihypertension therapy in consideration of cognitive decline.

Alcohol Consumption and Systemic Hypertension (from the Third National Health and Nutrition Examination Survey)

Epidemiological studies have established the association between excessive alcohol consumption and systemic hypertension (SH). However, there are conflicting reports of the association of low to moderate alcohol consumption with SH. The objective of the study was to examine the associations of alcohol consumption and blood pressure categories using the 2017 American College of Cardiology/American Heart Association high blood pressure guidelines. This analysis included 17,059 participants from the Third National Health and Nutrition Examination Survey. Alcohol consumption was ascertained by way of a questionnaire. Blood pressure (mm Hg) was measured during the in-home interview and the participant's visit to the mobile examination center. We used multivariable logistic regression models to examine cross-sectional associations of alcohol consumption and blood pressure categories based on new American College of Cardiology/American Heart Association High Blood Pressure guidelines. Models were adjusted for age, gender, income, and cardiovascular risk factors. Compared with never drinkers, moderate drinkers (7 to 13 drinks/week) had increased odds of prevalent stage 1 and stage 2 SH (odds ratio [95% confidence interval] 1.51 [1.22 to 1.87] and 1.55 [1.20 to 2.00]). Similarly, there were significantly higher odds of prevalent stage 1 and stage 2 SH among heavy drinkers (≥14 drinks/week) (odds ratio [95% confidence interval] 1.65 [1.33 to 2.05] and 2.46 [1.93 to 3.14]). We did not find any association between alcohol consumption and elevated blood pressure category. Response bias must be considered because alcohol consumption was self-reported. Our study indicates the need for further research to understand the potential mechanisms by which alcohol consumption increases the risk of SH. In conclusion, this analysis from a population-based survey showed an association between moderate and heavy alcohol consumption and a higher prevalence of SH.

Assessing Data Adequacy for High Blood Pressure Clinical Decision Support: A Quantitative Analysis.

This study examines guideline-based high blood pressure (HBP) and hypertension recommendations and evaluates the suitability and adequacy of the data and logic required for a Fast Healthcare Interoperable Resources (FHIR)-based, patient-facing clinical decision support (CDS) HBP application. HBP is a major predictor of adverse health events, including stroke, myocardial infarction, and kidney disease. Multiple guidelines recommend interventions to lower blood pressure, but implementation requires patient-centered approaches, including patient-facing CDS tools. We defined concept sets needed to measure adherence to 71 recommendations drawn from eight HBP guidelines. We measured data quality for these concepts for two cohorts (HBP screening and HBP diagnosed) from electronic health record (EHR) data, including four use cases (screening, nonpharmacologic interventions, pharmacologic interventions, and adverse events) for CDS. We identified 102,443 people with diagnosed and 58,990 with undiagnosed HBP. We found that 21/35 (60%) of required concept sets were unused or inaccurate, with only 259 (25.3%) of 1,101 codes used. Use cases showed high inclusion (0.9-11.2%), low exclusion (0-0.1%), and missing patient-specific context (up to 65.6%), leading to data in 2/4 use cases being insufficient for accurate alerting. Data quality from the EHR required to implement recommendations for HBP is highly inconsistent, reflecting a fragmented health care system and incomplete implementation of standard terminologies and workflows. Although imperfect, data were deemed adequate for two test use cases. Current data quality allows for further development of patient-facing FHIR HBP tools, but extensive validation and testing is required to assure precision and avoid unintended consequences.

PREVALENCE OF CHRONIC HYPERTENSION IN PREGNANT WOMEN FOLLOWING THE 2017 ACC/AHA GUIDELINE CHANGE IN DIAGNOSTIC CRITERIA FOR HYPERTENSION

Objective: To examine the effect of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline for high blood pressure (BP) on the prevalence of chronic hypertension in pregnant women. Design and method: We conducted a cross-sectional study among women aged 15–49 years who had a live or stillbirth between 2009 and 2014 within an integrated US healthcare system. We compared the prevalence of chronic hypertension by the 2017 ACC/AHA guideline (defined as BP &gt; = 130/80 mmHg) and the American College of Obstetricians and Gynecologists (ACOG) guideline (defined as BP &gt; = 140/90 mmHg) overall and stratified by maternal age at delivery and race/ethnicity. Chronic hypertension was defined as &gt; = 2 high BPs from outpatient encounters on different days within 30 days and taken &lt; = 20 weeks gestation. The lowest BP value was used when there were multiple measurements from a single encounter. Women dispensed antihypertensive medication and who had a diagnosis of hypertension were classified as having hypertension by both guidelines regardless of BP value. Results: A total of 143,191 unique pregnancies were included (mean age was 30.1 years; 51% Hispanic, 26% non-Hispanic White, 8% non-Hispanic Black, 13% Asian). The prevalence of hypertension by ACOG and AHA/ACC was 2.3% and 9.7%, respectively. Using the 2017 ACC/AHA guideline, we identified 108,512 (75.8%) women with normal BP (&lt;120/80 mmHg), 20,808 (14.5%) women with elevated BP (120–129/&lt; 80 mmHg), 12,658 (8.8%) with hypertension stage 1 (130–139/80–89 mmHg), and 1,213 (0.9%) with hypertension stage 2 (&gt; = 140/90 mmHg). Using ACOG criteria, 139,937 (97.7%) women had BP &lt; 140/90 mmHg (31,425 of these women (22.5%) had BP 120–139/80–89 mmHg) and 3,254 (2.3%) women had hypertension (27 of these women (0.8%) had severe hypertension defined as BP&gt; = 160/110 mmHg). Younger women and non-Hispanic whites and Hispanics experienced larger increases in the prevalence of hypertension by the 2017 ACC/AHA guideline (Figure). Conclusions: Adoption of the 2017 ACC/AHA guideline to define hypertension increased the prevalence of chronic hypertension in pregnancy over 300%. Further research is needed to examine whether this lower threshold for defining hypertension in pregnancy is associated with increased maternal and neonatal complications.

TRENDS IN STATUS OF HYPERTENSION IN SOUTH CHINA: RESULTS FROM TWO REPRESENTATIVE CROSS-SECTIONAL SURVEYS, 2012-2017

Abstract Objective: This study aims to investigate the long-term natural trends in the status of hypertension in south China from 2012–2017. Design and method: Two successive cross-sectional surveys were conducted in Guangdong Province in 2012 and 2017, which include 10970 and 36376 participants aged 35 to 75 from different area, respectively. A multistage, stratified and cluster random sampling method was used to enroll the participants. Hypertension was defined as a mean systolic blood pressure at least 140mmHg and/or a mean diastolic blood pressure at least 90 mmHg, and/or self-reported use of antihypertensive medication within past 2 weeks, according to the 2010 Chinese guidelines for the management of Hypertension. The prevalence and control rates of hypertension were also estimated according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) high blood pressure guideline. Results: In 2012, 39.3% participants had hypertension, whereas 37.6% participants had hypertension in 2017. The age-standardized prevalence was 34.7% [95% confidence interval (CI): 34.1–35.2] and 31.9% (95% CI: 31.6–32.2) in 2012 and 2017, respectively. The prevalence of prehypertension decreased from 14.5 to 13.1% from 2012 to 2017. Over the two study periods, 45.6 and 51.2% of those with hypertension were aware of their diagnosis in 2012 and 2017, respectively, and 40.8 and 44.9% were taking antihypertensive medications, respectively; the control rates increase from 15.1 to 17.0% and among those who received medical treatment 36.9 and 37.9% achieved control of BP, respectively. Based on the 2017 ACC/AHA guideline, prevalence of hypertension was 64.5% in 2012 and 59.1% in 2017. The control rate increased from 3.0 to 4.4% during this period. And among participants who received medical treatment, only 12.2 and 15.2% of participants achieve the target of hypertensive management in 2012 and 2017, respectively. Conclusions: During 2012 to 2017, the prevalence of hypertension in South China trended to be stable, and the rate of awareness, treatment and control increased but still low.

LOWERING CUTOFF FOR HYPERTENSION IS RAISING THREE TIMES HEALTH EXPENDITURE IN INDIA

Objective: Recently American College of Cardiology (ACC)/AHA high blood pressure guideline drops both the systolic and diastolic blood pressure levels by 10 mm Hg leading the rise of overall crude prevalence of hypertension among U.S. adults from 31.9% to 45.6%. Surely these recommendations suggesting target 130/80 based on almost 50% reduction in CV events and mortality but at the same time clubbed with a rise of hypotension and acute renal failure apart from possible increase in adverse events of hypertension medications. Design and method: Keeping aim to study the impact of reducing cut off for hypertension in developing country like India we screened apparently healthy 129710 individuals, who never checked their blood pressure before, picked at various public places after their due consent to reveal data without disclosing their identity for blood pressure measurement in seated position after five minutes rest with three readings and taken the average of last two readings. Their demographic and details of habit also recorded. Results: There has been a tremendous rise in prevalence from 16.49% to 44.71% while dropping the cut off from 140/90 to 130/80. Interestingly in younger population less than 30 years of age prevalence of hypertension has been 7.7% with classical cut off 140/90 but rising more than four times 33.11% when cut off drops to 130/80. In elderly population above 60 years, a considerable rise of more than double from 28.8% to 59.6% noted. Conclusions: For developing world it is not only a huge rise in health expenditure but also in a country like India where 72% population is less than 40 years of age, it imparts an impression of being sick in a larger part. With this new cut off every third youngster can be labelled hypertensive. As sympathetic overdrive plays a major role in young population with hypertension, it is necessary to find an appropriate cut off for them which can not be similar to elderly. Early use of anti-hypertensive drugs not only opens door to various side effects but also paves way for lightheaded, fatigue, weakness while endeavoring lower targets.

Characteristics of Populations Excluded From Clinical Trials Supporting Intensive Blood Pressure Control Guidelines.

BackgroundOnly one third of patients recommended intensified treatment by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline for high blood pressure would have been eligible for the clinical trials on which recommendations were largely based. We sought to identify characteristics of adults who would have been trial‐ineligible in order to inform clinical practice and research priorities.Methods and ResultsWe examined the proportion of adults diagnosed with hypertension who met trial inclusion and exclusion criteria, stratified by age, diabetes mellitus status, and guideline recommendations in a cross‐sectional study of the National Health and Nutrition Examination Survey, 2013–2016. Of the 107.7 million adults (95% CI, 99.3–116.0 million) classified as having hypertension by the ACC/AHA guideline, 23.1% (95% CI, 20.8%–25.5%) were below the target blood pressure of 130/80 mm Hg, 22.2% (95% CI, 20.1%–24.4%) would be recommended nonpharmacologic treatment, and 54.6% (95% CI, 52.5%–56.7%) would be recommended additional pharmacotherapy. Only 20.6% (95% CI, 18.8%–22.4%) of adults with hypertension would be trial‐eligible. The majority of adults <50 years were excluded because of low cardiovascular risk and lack of access to primary care. The majority of adults aged ≥70 years were excluded because of multimorbidity and limited life expectancy. Reasons for trial exclusion were similar for patients with and without diabetes mellitus.ConclusionsIntensive blood pressure treatment trials were not representative of many younger adults with low cardiovascular risk and older adults with multimorbidity who are now recommended more intensive blood pressure goals.

Coronary Artery Calcium Score for Personalization of Antihypertensive Therapy: A Pooled Cohort Analysis.

[Figure: see text].