Posted on Apr 19, 2018, 5 p.m.
Recent changes to blood pressure guidelines from the American Heart Association and American College of Cardiology may class an additional 31 million Americans as having hypertension, newly diagnosed patients may face difficulty with insurance coverage with their newly acquired label which falls under pre-existing conditions.
The recommendations include: lowering diagnostic threshold for hypertension from 140/80 mmHg to 130/80 mmHg in adults; lowering threshold of high risk adults with hypertension with existing CVD from 140/80 to 130/80 mmHg for drug treatment and lowering adult drug treatment thresholds with calculated 10 year-CVD risk ≥ 10%, or high risk, such as patients with renal disease or diabetes from 140/80 to 130/80 mmHg.
Wider disease definitions mean that more people will be labeled as unwell, even if the risk of disease is low, according to researchers, labeling a patient as having hypertension increases risk of depression and anxiety as compared to risk for patients with same blood pressure who haven’t been labelled. It could also mean more patients may experience adverse effects from treatments, and in places without universal health coverage newly diagnosed hypertension patients may face difficulty with insurance coverage with their newly acquired label which falls under pre-existing conditions, says Dr. Katy Bell.
ACC/AHA guidelines follow established patterns in medical specialties where disease definitions are more often widened than narrowed. Systolic blood pressure has poor reproducibility with a 10 mmHg deviation between measurements. Large proportions of adults have a true pressure near the 130 threshold, inherent variability of increases potential of hypertension being diagnosed adds Professor Paul Glasziou.
80% of newly diagnosed hypertension patients with this new guideline can expect to get no benefit in terms of the risk of cardiovascular disease reduction by lowering their blood pressure. 11% would have marginal benefits, and 9% would have a larger benefit according to the report.
These guidelines would class an additional 13.7% of adults as having hypertension, that would be 31 million Americans and 2.4 million Australians. Majority of these people, around 25 million, are at low risk and not recommended for drug treatment, researchers say doctors should not label them as having hypertension, and should continue to support healthy lifestyle choices regardless of blood pressure being above or below 130 mmHg; adding when starting blood pressure medication is a question risks of CVD should be estimated using a reliable calculator, and the potential harm and benefits discussed with the patient.
Materials provided by University of Sydney.
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Katy J. L. Bell, Jenny Doust, Paul Glasziou. Incremental Benefits and Harms of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline. JAMA Internal Medicine, 2018; DOI: 10.1001/jamainternmed.2018.0310