Table 1.
Projected number of US adults ≥ 45 years recommended and not recommended pharmacological antihypertensive treatment, CVD events expected under current SBP levels, and CVD potentially prevented in the next ten years by achieving and maintaining 2017 ACC/AHA and JNC7 Guideline-Recommended SBP Goals.
| US Adults, millions (95% CI) |
CVD events expected (95% CI) with current SBP levels, millions | Projected CVD events prevented (UR) with achieving guideline-recommended SBP goals, millions | |||
|---|---|---|---|---|---|
| JNC7 | 2017 ACC/AHA | Difference (UR) |
|||
| Currently not taking antihypertensive medication | |||||
| SBP <130 mm Hg | |||||
| Antihypertensive medication not recommended by 2017 ACC/AHA or JNC7 | 51.3 (44.5–58.1) |
3.6 (3.2–4.1) |
- | - | - |
| SBP 130 to <140 mm Hg | |||||
| Antihypertensive medication not recommended by 2017 ACC/AHA or JNC7 | 5.2 (3.6–6.7) |
0.2 (0.1–0.3) |
- | - | - |
| Antihypertensive medication recommended by the 2017 ACC/AHA but not by JNC7 | 3.5 (2.4–4.6) |
0.5 (0.4–0.6) |
- | 0.1 (0.0–0.2) |
0.1 (0.0–0.2) |
| Antihypertensive medication recommended by the 2017 ACC/AHA and by JNC7 | 3.0 (1.6–4.4) |
0.6 (0.5–0.8) |
0.1 (0.0–0.2) |
0.1 (0.0–0.2) |
0 |
| SBP ≥140 mm Hg | |||||
| Antihypertensive medication recommended by the 2017 ACC/AHA and by JNC7 | 11.4 (7.2–15.6) |
2.2 (1.5–3.0) |
0.8 (0.2–1.4) |
0.9 (0.3–1.6) |
0.1 (0.1–0.2) |
| Total | 74.3 (59.3–89.4) |
7.2 (5.9–8.7) |
0.8 (0.2–1.6) |
1.0 (0.3–1.9) |
0.2 (0.1–0.3) |
| Currently taking antihypertensive medication | |||||
| SBP <130 mm Hg | |||||
| Treatment intensification not recommended by the 2017 ACC/AHA or JNC7 | 24.7 (20.9–28.5) |
3.9 (3.6–4.1) |
- | - | - |
| SBP 130 to <140 mm Hg | |||||
| Treatment intensification recommended by the 2017 ACC/AHA but not JNC7 | 5.2 (3.8–6.6) |
0.7 (0.6–0.9) |
- | 0.1 (0.0–0.2) |
0.1 (0.0–0.2) |
| Treatment intensification recommended by the 2017 ACC/AHA and JNC7 | 5.0 (3.9–6.1) |
1.5 (1.3–1.7) |
0.2 (0.0–0.5) |
0.2 (0.0–0.5) |
0 |
| SBP ≥140 mm Hg | |||||
| Treatment intensification recommended by the 2017 ACC/AHA and by JNC7 | 13.8 (9.3–18.3) |
3.7 (3.0–4.6) |
1.5 (0.7–2.4) |
1.6 (0.8–2.5) |
0.1 (0.1–0.1) |
| Total | 48.7 (37.9–59.5) |
9.8 (8.5–11.3) |
1.7 (0.7–2.8) |
2.0 (0.8–3.2) |
0.2 (0.1–0.4) |
| Overall (Taking and not taking Antihypertensive Medication) | |||||
| Total | 123.1 (97.2–148.9) |
16.9 (14.3–19.5) |
2.6 (0.9–4.4) |
3.0 (1.1–5.1) |
0.5 (0.2–0.7) |
ACC: American College of Cardiology; AHA: American Heart Association; CI: confidence interval; CVD: cardiovascular disease; JNC7: Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; SBP: systolic blood pressure. In this table, recommendations for antihypertensive medication by the 2017 ACC/AHA high blood pressure guideline but not JNC7 include adults without diabetes or CKD (1) age ≥65 years with SBP 130–139 mm Hg and, or (2) with SBP/DBP 130–139/80–89 mm Hg with a history of CVD or a 10-year predicted CVD risk ≥10% on the Pooled Cohort risk equations. Recommendations for antihypertensive medication by the 2017 ACC/AHA high blood pressure guideline and JNC7 include (1) SBP/DBP 130–139/80–89 mm Hg with diabetes or CKD, and (2) SBP/DBP ≥140/80 mm Hg. Recommendation for intensification of antihypertensive medication by the 2017 ACC/AHA high blood pressure guideline but not by JNC7 guideline includes SBP 130–139 mm Hg without diabetes or CKD. Recommendations for intensification of antihypertensive medication by the 2017 ACC/AHA high blood pressure guideline and JNC7 include (1) SBP 130 to <140 mm Hg with diabetes or CKD, and (2) SBP ≥140 mm Hg.
UR: Uncertainty range. The uncertainty range represents the upper and lower bound from the analysis of extremes sensitivity analysis where the number of cardiovascular disease events prevented is recalculated using the upper and lower confidence bounds of both treatment effect size magnitude in the trials meta-analysis3 and REGARDS ten-year cardiovascular event rate.19–21 The lower bound is calculated using the upper bound of the hazard ratio and the lower bound of the REGARDS ten-year cardiovascular event rate. The upper bound is calculated using the lower bound of the hazard ratio and the upper bound of the REGARDS ten-year cardiovascular event rate.