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Abstract: SA-OR049

The New 2017 ACC/AHA Guideline for High Blood Pressure in Adults: How It Impacts Mexican Population and Healthcare System? An Analysis of the SALMEX Cohort

Session Information

Category: Hypertension and CVD

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

Authors

  • Martinez-Rueda, Armando Jezael, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
  • Olivas-Martínez, Antonio, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
  • Fonseca-Correa, Jorge Ignacio, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
  • Vega, Olynka, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
  • Correa-Rotter, Ricardo, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
Background

The new 2017 ACC/AHA High Blood Pressure Guidelines for Adults lower the threshold to define hypertension (HT). The impact of these new definitions on populations and health systems is poorly understood.

Methods

SALMEX was a cross-sectional study to evaluate Na+ and K+ intake as well as chronic non-communicable diseases prevalence in adults. Participants were recruited from 2010 to 2012. We included data from all subjects aged 20-64 yrs (n=990). HT prevalence and pharmacological treatment (TX) requirement were determined according to both: JNC 7 and 2017 ACC/AHA. Data was extrapolated to sex- and age-adjusted Mexico City’s (CDMX) population and annual costs of medical follow-up was calculated. The need for pharmacologic TX was assessed with the Atherosclerotic Cardiovascular Disease (ASCVD) score, and compared to Framingham scores (lipids and BMI).

Results

HT prevalence in the SALMEX cohort increased from 16.2% to 37.4% (18% to 39.3% adjusted to CDMX population). The proportion of subjects requiring pharmacological and non-pharmacological TX increased from 17.7% to 19.0% and from 17.7% to 37.4%, respectively (19.4% to 21.8% for pharmacological and 19.4% to 39.3% for non-pharmacological TX, adjusted to CDMX population). Medical follow-up annual costs for hypertensive subjects in CDMX would increase an estimated $59,278,928 USD. The indication to initiate pharmacological TX was similar when assessed by Framingham risk score with serum lipids values or with BMI, as compared to the ASCVD score, with correlation kappa indexes of 0.981 and 0.972 respectively.

Conclusion

The adoption of the new HT guidelines in Mexican population not only has implications on its prevalence but also on medical follow-up costs. Further pharmacoeconomic analysis is required to evaluate the potential impact of this new HT definition. Framingham BMI score represents the most cost-effective alternative to assess cardiovascular risk at diagnosis.

Prevalence, treatment and cost differences according to ACC/AHA 2017 and JNC 7 hypertension guidelines
Hypertension Prevalence

a) SALMEX (%)
b) Mexico City, age-adjusted§ (%)
2017 ACC/AHA

37.4%
39.3%
JNC 7


16.2%
18.0%
Non-pharmacological treatment

a) SALMEX, n (%)
b) Mexico City, age-adjusted§, n (%)
2017 ACC/AHA

370 (37.4)
2,083,155 (39.3)
JNC 7


175 (17.7)
1,027,171 (19.4)
Pharmacological treatment

a) SALMEX, n (%)
b) Mexico City, age-adjusted§, n (%)
2017 ACC/AHA

188 (19.0)
1,154,547 (21.8)
JNC 7


175 (17.7)
1,027,171 (19.4)
Cost of hypertension follow-up and treatment in Mexico City healthcare systemΩ

1) Pharmacologically treated subjects
2) Non-pharmacologically treated subjects
3) Mexico City population-cost increase per year
2017 ACC/AHA

$91,209,213
$49,216,224
$59,278,928
JNC 7


$81,146,509
$0
N/A
§Adjusted to 2010 age-sex distribution of Mexico City adult population.
Ω Based on costs of a public hospital in Mexico City, adjusted to 2018 USD.

Funding

  • Commercial Support