Potential Need for Expanded Clinical- and Community-based Pharmacologic Treatment and Lifestyle Modification Services Under the 2017 Hypertension Guideline.

Objective: Describe the effects of the 2017 Hypertension Guideline (HTN GL) compared to JNC-7 guideline on recommended blood pressure (BP) treatment status among US adults and identify the potential need for expanded clinical- and community-based BP management services. Methods: Analyze data from 2011-2014 National Health and Nutrition Examination Survey, with analytic sample of 10,031 aged ≥18 years. Results: The new HTN GL reclassifies 32.3 million US adults as newly hypertensive and recommends BP-related treatment for 133.7 million adults, including 4.9 million newly recommended pharmacologic therapy and 50.5 million newly recommended lifestyle modifications alone. An estimated 1.1 million adults newly recommended to initiate pharmacologic treatment and 20.6 million adults newly recommended lifestyle modification alone report not having established healthcare linkages. Application of the new HTN GL affects some groups significantly more than others in being reclassified as having hypertension or being newly recommended to initiate BP treatment. This includes adults aged 18-64 years and males, two groups who historically have limited access to or low utilization of healthcare services for hypertension management. In addition, 3.6 million of the 4.9 million US adults who are newly recommended pharmacologic treatment and 36.4 million of the 50.5 million of those newly recommended lifestyle modification alone, are overweight or obese. Conclusions: The new HTN GL results in millions of additional US adults being recommended for lifestyle modification to manage their BP and a smaller proportion for pharmaceutical treatment. With many of those individuals not having established linkages to healthcare, these results can aid in translating the new HTN GL into clinical practice and public health programs necessary to meet the increased demand for services. Expanded clinical and public health resources are likely to be required to manage the additional millions of US adults recommended to newly initiate pharmacologic treatment and/or lifestyle modification, including many who previously had only limited healthcare system interaction. Community-based prevention strategies can aid in addressing this added burden on the health care system.