New Blood Pressure Guidelines May Take Millions Off Hypertension Medications

New blood pressure treatment guidelines announced in February 2014 by the Eighth Joint National Committee (JNC 8) may result in nearly 6 million American adults no longer requiring hypertension medications, according to a study published March 29, 2014, in the Journal of the American Medical Association.

Anne-Marie Navar-Boggan, MD, a cardiology fellow at the Duke University School of Medicine, presented findings from the peer-reviewed analysis, which was the first to quantify the impact of the controversial guidelines that relaxed the blood pressure goal in adults aged 60 years and older, from 140/90 mm Hg to 150/90 mm Hg, as well as in adults with diabetes and kidney disease.

Navar-Boggan noted that the JNC 8’s decision to raise the blood pressure target in older adults was controversial, and “not all experts agree with this new recommendation.” Thus, researchers from the Duke Clinical Research Institute (DCRI) in collaboration with McGill University sought to determine the number of US adults affected by the changes.

Using data from 2005-2010 the National Health and Nutrition Examination Survey (NAHNES), which included more than 16,000 patients with blood pressure measurements, Navar-Boggan and her colleagues found “the proportion of US adults considered eligible for hypertension treatment (under the new guidelines) would decrease from 40.6% under the old guidelines to 31.7%.” Additionally, 13.5 million adults — most of whom are over age 60 — would no longer be categorized with poorly controlled blood pressure and would instead be considered adequately managed. Within that patient population, 5.8 million adults would no longer need blood pressure medications if the new guideline were strictly applied.

“This study reinforces how many Americans with hypertension fall into the treatment ‘gray zone’ where we don’t know how aggressive to treat and where we urgently need to conduct more research,” said Eric D. Peterson, MD, professor of medicine and director of DCRI.

Navar-Boggan said one in 4 adults over age 60 is currently being treated for hypertension and meeting the stricter targets set by earlier guidelines.

“These adults would be eligible for less-intensive blood pressure medication under the new guidelines, particularly if they were experiencing side effects,” Navar-Boggan said. “But many experts fear that increasing blood pressure levels in these adults could be harmful.”