OBJECTIVES : The American College of Cardiology (ACC) and American Heart Association (AHA) released updated guidelines which lower the blood pressure (BP) threshold for hypertension. We evaluated the impact of this change in a large healthcare-seeking population.

METHODS : The OM1 Data Cloud houses extensively linked and representative clinical and administrative data on tens of millions of patients in the United States. We performed analyses to evaluate the impact of the new ACC/AHA Hypertension Guidelines on over 14 million adults aged 20 years and older, who had BP measurements available, and were seen in an outpatient setting from January 2013 to November 2017. We identified patients with at least two systolic BP readings ≥130 mm Hg or two diastolic BP readings ≥80 mm Hg per the new guidelines, as well as those who met previous guideline definitions of systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg.

RESULTS : The 14 million adults included in this analysis had over 115 million BP measurements over the course of the study period. Under the old guidelines, 36% of the adults in our study cohort met criteria for high BP compared to 69% under the new guidelines. The biggest impact was seen in adults aged 45 years and younger, where the number of adults with hypertension more than doubled. Among the adults meeting criteria for high BP under the new guidelines, 58% already had a diagnosis of hypertension and 50% were on anti-hypertensive medications.

CONCLUSIONS : The new guidelines have a significant impact on the health care system with substantial increases in the number of adults, and particularly young adults, now newly eligible for diagnosis and needing either lifestyle modifications or anti-hypertensive medication. The new guidelines also result in more diagnosed and treated patients being classified as having inadequate control of their BP.