Background: In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) updated blood pressure (BP) guidelines to revise the definition of hypertension to 130/80mmHg or greater from 140/90mmHg, and to target treatment to less than 130/80mmHg. Changes were also made regarding the decision of which individuals should be recommended to commence antihypertensive therapy.
Method: 11247 participants were recruited by the Australian Diabetes, Obesity and Lifestyle Study (AusDiab), a cross-sectional survey conducted between May 1999 and December 2000 throughout Australia. Data was provided including BP measurements, laboratory results and questionnaire responses relating to medication use and risk factors such as smoking and diabetes. By applying our exclusion criteria, a total of 4682 participants were eligible for calculations.
Results: By following the ACC/AHA guidelines, the prevalence of hypertension would be 41.2% (95% CI, 39.75 42.57), 20.3% higher than the Australian Heart Foundation (AHF) 2016 guidelines, which would label 20.9% as hypertensive (95% CI, 19.70 22.03). Participants diagnosed by the ACA/AHA guidelines were younger with a mean age of 57.6 years (95% CI, 57.14-58.07) and displayed lower cardiovascular risk, cholesterol (LDL and total) levels. In those eligible for treatment, 8.1% would be recommended to commence BP lowering therapy, 3.2% greater than AHF guidelines.
Discussion: Similar findings have been reported in countries such as the United States and China. The updated ACC/AHA guidelines have been controversially received worldwide with differing opinions regarding the potential harms and benefits of applying these guidelines in clinical practice.
Implications for practice: These guidelines may significantly impact the delivery of health care in Australian general practice. A greater number of Australians with lower cardiovascular risk and fewer comorbidities would be classified as hypertensive. Moreover, in comparison with the AHF 2016 guidelines, a higher proportion would be recommended for antihypertensive treatment.