Abstract P109: Association Of The 2017 ACC/AHA Blood Pressure Guideline With Blood Pressure Change In Community-dwelling Older Adults Between 2016-2019: A Difference-in-differences Analysis In The ARIC Study

Introduction: In 2017, the ACC/AHA revised the blood pressure (BP) guideline to lower the BP threshold for diagnosing and treating hypertension in older adults. Pharmacologic treatment is recommended for systolic BP (SBP) ≥130 mmHg in all older adults aged ≥65 years. Data on BP changes before and after publication of the guideline are needed to inform quality of care initiatives. Methods: We included participants from the Atherosclerosis Risk in Communities Study who attended a pre-guideline (2016-2017) and post-guideline (2018-2019) visit with a pre-guideline SBP between 120-159 mm Hg. We categorized participants based on their pre-guideline SBP according to the 2017 guideline: not reclassified to treatment (SBP 120-129), reclassified to stage 1 hypertension (SBP 130-139), or reclassified to stage 2 hypertension (SBP 140-159). To estimate the association of the 2017 guideline with SBP change, we performed a quasi-experimental analysis using difference-in-differences (DiD) regression. We compared changes in SBP between participants affected (SBP 130-139, 140-159) and those not affected (SBP 120-129) by the new SBP target, adjusted for traditional risk factors. Results: Of 2195 participants aged 71-94 years, mean (SD) SBP was 137.2 (10.8) mm Hg, and 77% were on antihypertensive therapy at the pre-guideline visit. Among participants with SBP ≥130 pre-guideline, 31% were at goal SBP <130 post-guideline. In adjusted DiD analyses, participants with SBP ≥130 pre-guideline had significantly lower mean SBP at the post-guideline visit (Stage 1 hypertension: -5.0 [95% CI: -6.7, -3.3]; Stage 2 hypertension: -9.7 [-11.3, -8.0]) compared with participants with SBP 120-129 pre-guideline ( Table ). Results were similar when stratified by sex and race. Conclusions: In a sample of community-based older adults, the post-guideline period was associated with significantly lower SBP in those reclassified to Stage 1 or Stage 2 hypertension. However, significant gaps exist in BP control and only a minority met the updated treatment goal.