{
  "abstract": "Background In August 2020, the American Heart Association (AHA) and American College of Cardiology (ACC) released updated hypertension guidelines. Under the new guidelines, therapy is advised at blood pressure ≥130/80 mmHg in adults with diabetes, chronic kidney disease (CKD), or a PREVENT-estimated 10-year cardiovascular disease (CVD) risk ≥7.5%. The long-term population-level changes following these guidelines remains uncertain.Methods We analysed National Health and Nutrition Examination Survey (NHANES) 2009–2018 data linked to mortality through 2019. Hypertensive adults without baseline CVD were included. Treatment eligibility was defined using guideline criteria. Cox models estimated associations between antihypertensive therapy and all-cause and cardiovascular (CV) mortality.Results The weighted cohort represented 81.0 million U.S. adults with hypertension. Of these, 22.8 million (28%) were guideline-eligible for therapy; 13.1 million (57%) were treated, while 9.7 million (43%) remained untreated ( figure 1). Antihypertensive therapy was associated with a 23% reduction in all-cause mortality (HR 0.77, 95% CI 0.63–0.94) and 50% reduction in CV mortality (HR 0.50, 95% CI 0.36–0.68) (table 1). At 10 years, universal treatment of eligible but untreated adults was projected to prevent ~200,900 all-cause and ~162,600 CV deaths (table 2). Benefits were greatest in adults with diabetes (figure 2). Simulation analyses projected lives saved under partial treatment uptake (figure 3).Conclusions In this nationally representative cohort, nearly one in three U.S. adults with hypertension were newly eligible for therapy under the guideline, yet over two in five remained untreated. Extending treatment to all eligible adults could prevent more than 200,000 all-cause and 160,000 cardiovascular deaths over the next decade.*Lives saved were estimated under three population coverage scenarios for initiation of antihypertensive therapy among eligible U.S. adults (10%, 20%, and 50% uptake of treatment in those with diabetes, chronic kidney disease, or PREVENT CVD risk ≥7.5% and blood pressure ≥130/80 mmHg). Values represent median estimates with 95% percentile intervals derived from 1,000 bootstrap replications of absolute risk reduction.Abstract 191 Figure 1Eligibility for Treatment and Treatment Status of U.S. Hypertensive Adults Without Baseline Cardiovascular Disease in NHANES (2009–2018) According to the New Guideline’s Treatment ThresholdsAbstract 191 Figure 2Hazard Ratios for All-Cause and Cardiovascular Mortality with Antihypertensive Treatment Among Eligible Hypertensive U.S. Adults According to the New Guideline Recommendations with Blood Pressure ≥130/80 mmHg, Stratified by Diabetes, CKD, and PREVENT CVD Risk ≥7.5%. Adjusted for Baseline PREVENT CVD Risk. Reference group = Eligible Adults Not on Antihypertensive TreatmentAbstract 191 Table 1Hazard ratios for all-cause and cardiovascular mortality associated with antihypertensive treatment in adults without clinical CVD but with diabetes, CKD, or PREVENT CVD risk ≥7.5% and BP ≥130/80 mmHgOutcomeN eligibleEvents (n)aHR (treated vs untreated)*95% CIp-valueAll-cause mortality22,778,7124,648,6130.770.63 – 0.940.009Cardiovascular mortality22,778,7121,467,2730.500.36 – 0.68<0.001*Models were adjusted for baseline CV risk. Reference group = eligible adults not on antihypertensive treatment.Abstract 191 Table 2Absolute risk reduction and estimated lives saved with antihypertensive treatment among eligible hypertensive U.S. adults with diabetes, CKD, or elevated PREVENT CVD risk (≥7.5%) and blood pressure ≥130/80 mmHg, according to the new guideline recommendationsOutcomeTime HorizonRisk if Untreated (R0)1Risk if Treated (R1)1Absolute Risk Reduction (ARR)1Lives saved (Point Estimate)1Lives saved (Bootstrap Median, (95% CI)2All-cause mortalityAll-cause mortalityAt 1 year1.4%1.1%0.3%29,16631,207 (7,303–65,883)All-cause mortalityAt 5 years4.2%3.3%1.0%97,21991,877 (21,627–191,787)All-cause mortalityAt 10 years9.6%7.5%2.1%204,160200,914 (48,446–408,282)Cardiovascular mortalityCardiovascular mortalityAt 1 year1.1%0.5%0.5%48,60950,742 (19,167–102,052)Cardiovascular mortalityAt 5 years1.3%0.6%0.6%58,33160,557 (22,493–123,681)Cardiovascular mortalityAt 10 years3.4%1.8%1.7%165,272162,620 (62,920–317,347)1R0 or R1 = 1 minus survival probability in control or treatment group. ARR = absolute difference in standardised risks (R0 − R1). Lives saved use the treat-the-gap scenario. Lives saved computed as ARR × Nuntreated, with Nuntreated = 9,721,899. Lives Saved (bootstrap median, 95% CI): Derived from 1,000 bootstrap replications of ARR estimates; values represent the median and 95% percentile interval.Abstract 191 Figure 3Estimates of lives saved with antihypertensive treatment, stratified by coverage rate and time horizon among eligible hypertensive U.S. adults according to the new guideline recommendations*, a) all-cause mortality and b) CV mortality",
  "authors": [
    {
      "affiliations": [
        "Keele University, Stoke-on-Trent, United Kingdom",
        "Manchester University, Manchester, United Kingdom",
        "Queen Mary University of London, London, United Kingdom",
        "University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom"
      ],
      "name": "Mustafa Al-Jarshawi"
    },
    {
      "affiliations": [
        "New York University, New York, United States"
      ],
      "name": "Sripal Bangalore"
    },
    {
      "affiliations": [
        "University of Toronto, Toronto, Canada"
      ],
      "name": "Prof Harindra Wijeysundera"
    },
    {
      "affiliations": [
        "National University Heart Centre, Singapore, Singapore"
      ],
      "name": "Nicholas Chew"
    },
    {
      "affiliations": [
        "Royal North Shore Hospital and Kolling Insitute, Sydney, Australia"
      ],
      "name": "Anastasia Mihailidou"
    },
    {
      "affiliations": [
        "McMaster University, Hamilton, Canada"
      ],
      "name": "Harriette Van Spall"
    },
    {
      "affiliations": [
        "Keele University, Stoke-on-Trent, United Kingdom"
      ],
      "name": "Mamas Mamas"
    }
  ],
  "title": "191 Population-level 10-year implications of the new 2020 AHA/ACC hypertension guideline recommendations for primary prevention in the United States: a NHANES-based cohort study (2009-2018)",
  "uid": "46309d1f-67e6-5322-85a9-4bf9abdf483e"
}