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Clinical outcomes and economic impact of the 2017 ACC/AHA guidelines on hypertension in China.

ABSTRACT: The 2017 guidelines on the diagnosis and treatment of high blood pressure in adults were published by the American College of Cardiology and the American Heart Association. The impact on clinical outcomes and costs needs to be estimated prior to adopting these guidelines in China. Data from a nationally representative sample in China were analyzed. The prevalence and treatment were calculated based on the criteria of the 2017 guidelines and 2018 Chinese guidelines among participants aged ≥35 years old. Direct medical costs, as well as the averted disability adjusted of life years and cost saving from cardiovascular disease events prevented by controlling hypertension, were also estimated. The prevalence and treatment rate of hypertension were 32.0% and 43.4% according to the 2018 Chinese guidelines. Based on the 2017 guidelines, another 24.5% of the adult population (estimated 168.1 million) would be classified as having hypertension; of whom, about 32.1 million would need to be pharmaceutically treated to reach the current treatment rate of 43.4%. As a result, an estimated additional 42.7 billion US dollars of the direct medical cost would be required for lifetime therapy. By preventing cardiovascular events, the new guidelines would reduce lifetime costs by 3.77 billion US dollars, while preventing 1.41 million disability adjusted of life years lost. Application of the 2017 guidelines in China will substantially increase the prevalence of hypertension and produce a large increase in therapy costs, although it would prevent cardiovascular disease events and save disability adjusted of life years.

SUBMITTER: Wang Z

PROVIDER: S-EPMC8030413 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:To examine the effect of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines on the prevalence of hypertension and eligibility for initiation and intensification of treatment in nationally representative populations from the United States and China.Observational assessment of nationally representative data.US National Health and Nutrition Examination Survey (NHANES) for the most recent two cycles (2013-14, 2015-16) and China Health and Retirement Longitudinal Study (CHARLS) (2011-12).All 45-75 year old adults who would have a diagnosis of hypertension and be candidates for treatment on the basis of the ACC/AHA guidelines, compared with current guidelines.Diagnosis of hypertension and candidacy for initiation and intensification of antihypertensive treatment.Adoption of the 2017 ACC/AHA hypertension guidelines in the US would label 70.1 (95% confidence interval 64.9 to 75.3) million people in the 45-75 year age group as having hypertension, representing 63% (60.6% to 65.4%) of the population in this age group. Their adoption in China would lead to labeling of 266.9 (252.9 to 280.8) million people or 55% (53.4% to 56.7%) of the same age group as having hypertension. This would represent an increase in prevalence of 26.8% (23.2% to 30.9%) in the US and 45.1% (41.3% to 48.9%) in China. Furthermore, on the basis of treatment patterns and current guidelines, 8.1 (6.5 to 9.7) million Americans with hypertension are untreated, which would be expected to increase to 15.6 (13.6 to 17.7) million after the implementation of the ACC/AHA guidelines. In China, on the basis of current treatment patterns, 74.5 (64.1 to 84.8) million patients with hypertension are untreated, estimated to increase to 129.8 (118.7 to 140.9 million. In addition, the ACC/AHA guidelines would label 8.7 (6.0 to 11.5) million adults in the US and 51 (40.3 to 61.6) million in China as having hypertension that would not require antihypertensive treatment, compared with 1.5 (1.2 to 2.1) million and 23.4 (12.1 to 35.1) million with the current guidelines. Finally, even among people receiving treatment, the proportion that are candidates for intensification of treatment is estimated to increase by 13.9 (12.2 to 15.6) million (from 24.0% to 54.4% of treated patients) in the US, and 30 (24.3 to 35.7) million (41.4% to 76.2% of treated patients) in China, if the ACC/AHA treatment targets are adopted.If adopted, the 2017 ACC/AHA hypertension guidelines will markedly increase the number of people labeled as having hypertension and treated with drugs in both the US and China, leading to more than half of those aged 45-75 years in both countries being considered hypertensive.

Project description:BackgroundFew studies investigated the concordance in hypertension status and antihypertensive treatment recommendations between the 2018 Chinese Hypertension League (CHL) guidelines and the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines and assessed the change of premature mortality risk with hypertension defined by the ACC/AHA guidelines.MethodsWe used the baseline data of the China Health and Retirement Longitudinal Study (CHARLS) to estimate the population impact on hypertension management between CHL and ACC/AHA guidelines. Mortality risk from hypertension was estimated using the data from China Health and Nutrition Survey (CHNS). Cox proportional hazards model was used to estimate the hazard ratios (HRs) and their 95% confidence intervals(CIs).ResultsAmong 13,704 participants analyzed from the nationally representative data of CHARLS, 42.64% (95% CI: 40.35, 44.96) of Chinese adults were diagnosed by both CHL and ACC/AHA guidelines. 41.25% (39.17, 43.36) did not have hypertension according to either guideline. Overall, the concordance in hypertension status was 83.89% (81.69, 85.57). A high percentage of agreement was also found for recommendation to initiate treatment among untreated subjects (87.62% [86.67, 88.51]) and blood pressure (BP) above the goal among treated subjects (71.68% [68.16, 74.95]). Among 23,063 adults from CHNS, subjects with hypertension by CHL had a higher risk of premature mortality (1.75 [1.50, 2.04]) compared with those without hypertension. The association diminished for hypertension by ACC/AHA (1.46 [1.07, 1.30]). Moreover, the excess risk was not significant for the newly defined Grade 1 hypertension by ACC/AHA (1.15 [0.95, 1.38]) when compared with BP <120/80 mmHg. This contrasted with the estimate from CHL (1.54 [1.25, 1.89]). The same pattern was observed for total mortality.ConclusionsIf ACC/AHA guidelines were adopted, a high degree of concordance in hypertension status and initiation of antihypertensive treatment was found with CHL guidelines. However, the mortality risk with hypertension was reduced with a non-significant risk for Grade 1 hypertension defined by the ACC/AHA.

Project description:Background: The recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines redefined blood pressure levels 130-139/80-89 mmHg as stage 1 hypertension. However, the association of stage 1 hypertension with cardiovascular disease (CVD) and its age-specific differences among the rural women in Liaoning province remains unclear. It needs to be quantified in considering guideline adoption in China. Methods: In total, 19,374 women aged ≥35 years with complete data and no cardiovascular disease at baseline were followed in a rural community-based prospective cohort study of Liaoning province, China. Follow-up for the new cases of CVD was conducted from the end of the baseline survey to the end of the third follow-up survey (January 1, 2008-December 31, 2017). Adjusted Cox proportional hazards models were applied to estimate the Hazard Ratios (HR) and 95% Confidence Intervals (CI) with the normal blood pressure as a reference. Results: During the median follow-up period of 12.5 years, 1,419 subjects suffered all-cause death, 748 developed CVD, 1,224 participants suffered stroke and 241 had Myocardial Infarction (MI). Compared with normal BP, Stage 1 hypertension had a HR (95% CI) of 1.694 (1.202-2.387) in CVD mortality, 1.575 (1.244-1.994) in the incidence of stroke. The results obtained that the risk of CVD mortality and incidence of stroke was significantly associated with stage 1 hypertension in rural women aged ≥45 years after adjusting for other potential factors. However, in participants aged 35-44 years, stage 1 hypertension was not associated with an increased risk of cardiovascular disease. Conclusions: The newly defined stage 1 hypertension is associated with an increased risk of CVD mortality and also incidence of stroke in the rural women aged ≥45 years population of Liaoning province. This study can be a good reference for health policy makers and clinicians workers to make evidence-based decisions toward lowering burden of cardiovascular disease more efficient, timely measures on prevention and control of stage 1 hypertension in China.

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Clinical outcomes and economic impact of the 2017 ACC/AHA guidelines on hypertension in China.

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