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Proposed changes to diagnosis criteria labels millions more as hypertensive
Clinical Question
What is the effect of changing the definition of hypertension?
Bottom line
To paraphrase the Bard: Is a diagnosis by any other criteria still the same diagnosis? This study found that recent guidelines (2017) from the American College of Cardiology (ACC) and the American Heart Association (AHA), which have not been endorsed by other groups, would immediately classify more than 70 million Americans and more than 266 million Chinese as having hypertension, many of them eligible for treatment. Translated, in the range of 45 to 75 years of age, 63% of the United States population and 55% of China's population would be classified as having a risk factor for cardiovascular disease (no analysis, yet, of other countries). Although a boon for the pharmaceutical and life insurance industries, these numbers could overwhelm national health systems and provide little benefit to their populations (POEM 200821). 4
Reference
Study design: Other
Funding: Self-funded or unfunded
Setting: Population-based
Synopsis
The ACC and AHA recently released their recommendations for the diagnosis and treatment of high blood pressure, lowering the threshold to 130/80 mm Hg, largely based on the results of a single study (SPRINT) that did not measure blood pressure in the typical way. For this observational study, the authors identified all patients aged 45 to 75 years with at least 2 blood pressure measurements and information on prescription drug use in the United States and China using the US National Health and Nutrition Examination Survey for the most recent 2 cycles (2013-14, 2015-16) and the China Health and Retirement Longitudinal Study (2011-12). The authors applied the new threshold, as well as recommendations for treatment by these groups, to these cohorts. They calculate the recommendations would label 70.1 million (95% CI 64.9 - 75.3 million) people in the United States and 266.9 million (252.9 - 280.8 million) people in China in this age range as having hypertension. These increases represent 63% (60.6% - 65.4%) of the US population and 55% (53.4% - 56.7%) of the population of China in this age group. An additional 3.9 to 11.2 million people in the United States and 33.9 to 76.8 million in people in China would require treatment and 12.2 to 15.6 million Americans and 24.3 to 35.7 million Chinese would require intensification of treatment.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Is this an “Corporate Medicine Business Plan”?
Agree with reviewer. One SPRINT study, 300 million new prescriptions, every year. Great return for Big Pharma. Again.
Just read this POEM following which I felt the need to take my own BP = 133/77. Took it again an hour later. Even worse off - 133/82. Am I going to run out and start BP meds just like AHA says I should? NOT!! I suspect my BP will recover once I get over having read this POEM.
Good poem
Great POEM, thanks,
This says it all:
“Although a boon for the pharmaceutical and life insurance industries, these numbers could overwhelm national health systems and provide little benefit to their populations”
Much the same as 'diagnosising' someone who has a garage full of stuff no-one else wants but which they don't want to throw away as a 'Hoarding Disorder' under DSM V.
This development is reminiscent of the promotion of statin use. For many millions it thrusts forward an issue where there isn’t one, for the targeted vast financial benefit of the few. Enormous populations are exposed to harms which many authors have wisely documented. The harm to come of the doctor-patient trust is incalculable. The ACC and AHA are fomenting bad medicine at its worst.
Guidelines ie, the opinion of a group of scholars, has invaded one of the main principles of medicine: treat your patients as an individual, not as one size fits all.
This is an example of how these experts jump to a conclusion that may harm many people, based on the results of a SINGLE study. Moreover, in this single study they measured the BP not in a typical way that you and do.
I will not change may practice until the results of Sprint are duplicated by a different group of researchers.
Go Big Pharma!
I don't treat high blood pressure but I want make patient blood pressure is acceptable I believe systolic bp of 80 is low normal and does not for normal variation with that kind of control cerebral ischemic attack especially in elderly more common which can result in fall injury and stroke during my practice I have called to ER to see few of them, One of my mentor always told us treat the patient
Not imaging or guideline if body is different and have different requirement and tolerance.
Excellent
Changing the definition changes the whole thing. It does, however, allow some who prefer a different definition to act differently. We all have our own criteria.
This shows so much Big Pharma bias. They seem to want to put everyone on meds.