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Abstract: TH-PO439

New Guidelines Shift Prevalence of Elevated Blood Pressure (BP) Among US Adults Both with and Without CKD

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention


  • Rodrigue, Joanne E., University of California San Francisco, San Francisco, California, United States
  • Banerjee, Tanushree, San Francisco General Hospital , San Francisco, California, United States
  • Johansen, Kirsten L., University of California, San Franicsco, San Francisco, California, United States
  • Bragg-Gresham, Jennifer L., University of Michigan, Ann Arbor, Michigan, United States
  • Saydah, Sharon, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
  • Powe, Neil R., Priscilla Chan and Mark Zuckerberg San Francisco Gen Hosp & UCSF, San Francisco, California, United States

In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) published guidelines that redefine criteria for hypertension (HTN) using a lower threshold of BP. We sought to determine the number of individuals reclassified as having HTN by prior treatment with antihypertensive medication (Rx) and presence or absence of CKD.


We used National Health and Nutrition Examination Survey data (1999-2014) to estimate the total number of non-pregnant adults aged ≥20 years who would have been reclassified from having pre-HTN (systolic BP [SBP] 120-139 mmHg) per the 2003 Seventh Report of the Joint National Committee (JNC7) BP guidelines to having elevated BP (SBP 120-129 mmHg) or stage 1 HTN (SBP 130-139 mmHg) per 2017 ACC/AHA definitions. BP measures were averaged from three readings taken during medical examination, and medication use was obtained from the household interview. We further examined the number of people with and without CKD having HTN status reclassified. CKD was defined as having an estimated glomerular filtration rate (eGFR) between 15-59 ml/min/1.73m2 or eGFR ≥60 mL/min/1.73m2 with urine albumin to creatinine ratio ≥30 mg/g.


About two-thirds of people initially defined as having pre-HTN in the JNC7 were reclassified to stage 1 HTN according to the ACC/AHA guidelines. The proportion was similar among individuals with and without CKD; among those receiving and not receiving pharmacologic treatment for HTN; and over time. This represents approximately one-quarter to one-third of all adults with CKD (28 M; 16 M on Rx) or without CKD (173 M; 36 M on Rx).


According to the latest guidelines, during the period 1999-2014, a large proportion of people would have been reclassified from pre-HTN to stage 1 HTN. In addition, these results suggest that the new guidelines may stimulate intensification of therapy for individuals already being treated for HTN, whether or not they have CKD.

Pre-HTN Reclassified by New BP Guideline n (% of 201M U.S. adults)
Survey YearsTreated with RxNot Treated with Rx
1999-2014Elevated BPStage 1 HTNElevated BPStage 1 HTN
CKD2 M (14.7)4 M (28.5)2 M (14.5)4 M (29.5)
No CKD6 M (17.6)12 M (34.2)22 M (15.9)32 M (23.1)



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