PMID- 37071434
OWN - NLM
STAT- MEDLINE
DCOM- 20230505
LR  - 20230911
IS  - 1473-5598 (Electronic)
IS  - 0263-6352 (Print)
IS  - 0263-6352 (Linking)
VI  - 41
IP  - 6
DP  - 2023 Jun 1
TI  - The prevalence and treatment of hypertension in Veterans Health Administration, 
      assessing the impact of the updated clinical guidelines.
PG  - 995-1002
LID - 10.1097/HJH.0000000000003424 [doi]
AB  - OBJECTIVE: Hypertension is the most common risk factor for cardiovascular disease 
      (CVD). Several guidelines have lowered diagnostic blood pressure (BP) thresholds 
      and treatment targets for hypertension. We evaluated the impact of the more 
      stringent guidelines among Veterans, a population at high risk of CVD. METHODS: 
      We conducted a retrospective analysis of Veterans with at least two office BP 
      measurements between January 2016 and December 2017. Prevalent hypertension was 
      defined as diagnostic codes related to hypertension, prescribed antihypertensive 
      drugs, or office BP values according to the BP cutoffs at least 140/90 mmHg 
      (Joint National Committee 7 [JNC 7]), at least 130/80 mmHg [American College of 
      Cardiology/American Heart Association (ACC/AHA)], or the 2020 Veterans Health 
      Administration (VHA) guideline (BP >/=130/90 mmHg). Uncontrolled BP was defined per 
      the VHA guideline as mean SBP >/=130 mmHg or DBP >/=90 mmHg. RESULTS: The prevalence 
      of hypertension increased from 71% for BP at least 140/90 to 81% for BP at least 
      130/90 mmHg and further to 87% for BP at least 130/80 mmHg. Among Veterans with 
      known hypertension ( n  = 2 768 826), a majority [ n  = 1 818 951 (66%)] were 
      considered to have uncontrolled BP per the VHA guideline. Lowering the treatment 
      targets for SBP and DBP significantly increased the number of Veterans who would 
      require initiation of or intensification of pharmacotherapy. The majority of 
      Veterans with uncontrolled BP and at least one CVD risk factor remained 
      uncontrolled after 5 years of follow-up. CONCLUSION: Lowering the BP diagnostic 
      and treatment cutoffs increases the burden on healthcare systems significantly. 
      Targeted interventions are needed to achieve the BP treatment goals.
FAU - Yamada, Masaaki
AU  - Yamada M
AD  - Center for Access & Delivery Research and Evaluation, Iowa City VAMC.
AD  - The University of Iowa Roy J. and Lucille A Carver, College of Medicine.
FAU - Wachsmuth, Jason
AU  - Wachsmuth J
AD  - The University of Iowa Roy J. and Lucille A Carver, College of Medicine.
FAU - Sambharia, Meenakshi
AU  - Sambharia M
AD  - The University of Iowa Roy J. and Lucille A Carver, College of Medicine.
FAU - Griffin, Benjamin R
AU  - Griffin BR
AD  - Center for Access & Delivery Research and Evaluation, Iowa City VAMC.
AD  - The University of Iowa Roy J. and Lucille A Carver, College of Medicine.
FAU - Swee, Melissa L
AU  - Swee ML
AD  - The University of Iowa Roy J. and Lucille A Carver, College of Medicine.
FAU - Reisinger, Heather Schacht
AU  - Reisinger HS
AD  - Center for Access & Delivery Research and Evaluation, Iowa City VAMC.
AD  - The University of Iowa Roy J. and Lucille A Carver, College of Medicine.
AD  - Institute for Clinical and Translational Science, Iowa City, Iowa.
FAU - Lund, Brian C
AU  - Lund BC
AD  - Center for Access & Delivery Research and Evaluation, Iowa City VAMC.
FAU - Girotra, Saket R
AU  - Girotra SR
AD  - Division of Cardiovascular Medicine, Department of Internal Medicine, University 
      of Texas Southwestern Medical Center, Dallas, Texas, USA.
FAU - Sarrazin, Mary V
AU  - Sarrazin MV
AD  - Center for Access & Delivery Research and Evaluation, Iowa City VAMC.
AD  - The University of Iowa Roy J. and Lucille A Carver, College of Medicine.
FAU - Jalal, Diana I
AU  - Jalal DI
AD  - Center for Access & Delivery Research and Evaluation, Iowa City VAMC.
AD  - The University of Iowa Roy J. and Lucille A Carver, College of Medicine.
LA  - eng
GR  - R01 HL134738/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20230417
PL  - Netherlands
TA  - J Hypertens
JT  - Journal of hypertension
JID - 8306882
RN  - 0 (Antihypertensive Agents)
SB  - IM
MH  - United States/epidemiology
MH  - Humans
MH  - Antihypertensive Agents/therapeutic use/pharmacology
MH  - Prevalence
MH  - Retrospective Studies
MH  - Veterans Health
MH  - *Hypertension/diagnosis/drug therapy/epidemiology
MH  - *Cardiovascular Diseases/epidemiology
MH  - *Hypotension
MH  - Blood Pressure/physiology
PMC - PMC10158602
COIS- There are no conflicts of interest.
EDAT- 2023/04/19 06:00
MHDA- 2023/05/05 06:42
PMCR- 2023/05/04
CRDT- 2023/04/18 11:33
PHST- 2023/05/05 06:42 [medline]
PHST- 2023/04/19 06:00 [pubmed]
PHST- 2023/04/18 11:33 [entrez]
PHST- 2023/05/04 00:00 [pmc-release]
AID - 00004872-202306000-00014 [pii]
AID - JH-D-22-00316 [pii]
AID - 10.1097/HJH.0000000000003424 [doi]
PST - ppublish
SO  - J Hypertens. 2023 Jun 1;41(6):995-1002. doi: 10.1097/HJH.0000000000003424. Epub 
      2023 Apr 17.