A comparison of the impact of the 2017 ACC/AHA hypertension guidelines on primary care populations with and without diabetes [abstract]
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Background: Our objective was to assess the impact on primary care of the 2017 ACC/AHA lowering of the threshold for diagnosing HTN to a BP ≥ 130/80 mm Hg, and pharmacologic treatment intensification recommendations for patients with high CV risk and/or DM who have BP levels 130-139/80-89 mm Hg. Discussion: 62% of patients with DM and 57% without DM had a BP ≥ 130/80 mm Hg, and over half of these will require reclassification of HTN due to BP 130-139/80-89 mm Hg.Of patients with Stage 1 HTN, 76.8% of patients with DM and 39.4% without DM are already treated (but above goal). 25% of all DM patients (7755/30,608) and 13% of all non-DM patients (22963/176,555) are currently treated with Stage 1 HTN and will require an increase in BP medication to achieve BP < 130/80 mm Hg.7.7% of all DM patients (2344/30,608) and 2.3% of all non- DM patients with CV risk ≥ 10% (3960/176,555) are currently untreated with Stage 1 HTN and medication initiation will be recommended. If pharmacologic treatment initiation recommendations were limited to those with CV risk ≥ 10% for DM patients, BP medication initiation recommendations would decrease from 7.7% to 2.9% (896/30,608) of the DM population. Conclusion: The 2017 ACC/AHA guideline will result in a significantly increased need for primary care to address BP medication intensification, with a much greater proportional impact on those with DM compared to those without.