ACC/AHA vs ESC/ESH guideline: Assessing impact on hypertension prevalence, treatment
Implementing the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline over that of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) will give rise to a substantial increase in the prevalence of hypertension, as well as the number of adults who should receive medication, according to a study.
“There is room for improvement in lifestyles and cardioprotective treatment in individuals with blood pressure (BP) of 130–139/80–89 mm Hg whether they are called hypertensive (ACC/AHA) or not (ESC/ESH),” the authors said.
Hypertension prevalence using the ACC/AHA guidelines was 46.9 percent (95 percent CI, 46.0–47.8 percent), while that of the ESC/ESH guideline was 33.1 percent (32.2–33.9 percent); antihypertensive medication was recommended for 33.5 percent (32.7–34.3 percent) and 37.2 percent (36.2–38.1 percent) of adults, respectively.
Using the ACC/AHA vs the ESC/ESH guideline resulted in 5.3 more million hypertensive patients and 1.4 more million candidates for medication (for a 40-million adults’ country).
Some cardiometabolic goals (eg, nonsmoking, reduced salt consumption, low-density lipoprotein cholesterol, lifestyle medical advice and treatment with renin–angiotensin-system blockers) were achieved less frequently by participants who were hypertensive under the ACC-AHA compared to those who were hypertensive under the ESC/ESH guideline.
“We suggest that clinical-practice guidelines should consider the public health and costs implications, and not only the evidence on effectiveness and cost-effectiveness, of their recommendations,” the authors said.
In this study, data from a national survey on 12,074 individuals (aged ≥18 years) representative of the population in Spain were analysed. Standardized procedures were used to measure BP.
“Unlike the 2018 ESC/ESH guideline, the 2017 ACC/AHA guideline has recommended a shift in hypertension definition from BP 140/90–130/80 mm Hg. Further, they proposed somewhat different indications for antihypertensive medication,” the authors noted.