[2026-07-24] Potential Impact of the 2017 ACC/AHA Hypertension Guideline Compared With the 2024 Thai Guideline: A Population-Based Analysis Using NHSO/UCS Data

Supassara Luangjaru; Daruneewan Warodomwichit; Prin Vathesatogkit

doi:10.33165/rmj.2027.e277636

Authors

Supassara Luangjaru Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0009-0001-9980-613X
Daruneewan Warodomwichit Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Prin Vathesatogkit Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33165/rmj.2027.e277636

Keywords:

Hypertension, 2017 ACC/AHA guideline, 2024 Thai hypertension guideline, Prevalence, Antihypertensive therapy

Abstract

Background: Hypertension is a major public health challenge in Thailand. The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline lowered the diagnostic threshold for hypertension compared with the 2024 Thai guideline, which may affect prevalence estimates and treatment requirements.

Objective: To compare the prevalence of newly diagnosed hypertension and the number of individuals eligible for antihypertensive therapy under the 2017 ACC/AHA and the 2024 Thai guidelines.

Methods: A descriptive analytic study was conducted using the 2022 Thai National Health Security Office data. This study included 1 406 008 adults aged 18-100 years without prior hypertension. Blood pressure levels and comorbidities were analyzed to estimate hypertension prevalence and treatment eligibility based on both guidelines.

Results: Hypertension prevalence was 44.5% (95% CI, 44.4-44.5) by the 2017 ACC/AHA definition compared with 19.9% (95% CI, 19.9-20.0) by the 2024 Thai definition. Extrapolated to the Thai population, this equates to 23.6 million vs 10.6 million adults, respectively, a difference of 13.0 million cases. However, the number of individuals recommended for antihypertensive medication was nearly identical: 10.6 million (ACC/AHA) vs 10.6 million (Thai).

Conclusions: Adoption of the 2017 ACC/AHA guideline would substantially increase the number of Thai adults classified as hypertensive without proportionally increasing those requiring pharmacological treatment. Broader diagnostic criteria may improve early detection and awareness but must be balanced against healthcare capacity and resource implications.

References

Thai Hypertension Society. 2019 Thai Guidelines on the Treatment of Hypertension. Trick Think; 2019. Accessed 1 June 2026. https://thaihypertension.org/wp-content/uploads/2019/08/440.HT-guideline-2019.with-watermark-1.pdf

Chantkran W, Chaisakul J, Rangsin R, Mungthin M, Sakboonyarat B. Prevalence of and factors associated with stroke in hypertensive patients in Thailand from 2014 to 2018: a nationwide cross-sectional study. Sci Rep. 2021;11(1):17614. doi:10.1038/s41598-021-96878-4

Castelli WP. Epidemiology of coronary heart disease: the Framingham study. Am J Med. 1984;76(2A):4-12. doi:10.1016/0002-9343(84)90952-5

Kunanon S, Chattranukulchai P, Chotruangnapa C, et al. 2019 Thai Guidelines on the Treatment of Hypertension: executive summary. J Med Assoc Thai. 2021;104(10):1729-1738. doi:10.35755/jmedassocthai.2021.10.12199

Aekplakorn W, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Putwatana P. Prevalence of diabetes and relationship with socioeconomic status in the Thai population: National Health Examination Survey, 2004-2014. J Diabetes Res. 2018;2018:1654530. doi:10.1155/2018/1654530

Aekplakorn W, Puckcharern H, Satheannoppakao W. Thailand National Health and Examination Survey, NHES VI 2019-2020. Aksorn Graphic and Design Publishing; 2021. Accessed 1 June 2026. https://www.hiso.or.th/hiso/picture/reportHealth/report/sreport6/sreport6_full.pdf

Aekplakorn W, Chariyalertsak S, Kessomboon P, et al. Trends in hypertension prevalence, awareness, treatment, and control in the Thai population, 2004 to 2020. BMC Public Health. 2024;24(1):3149. doi:10.1186/s12889-024-20643-1

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-1324. doi:10.1161/HYP.0000000000000066

Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252. doi:10.1161/01.HYP.0000107251.49515.c2

SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103-2116. doi:10.1056/NEJMoa1511939

Zhang W, Zhang S, Deng Y, et al. Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med. 2021;385(14):1268-1279. doi:10.1056/NEJMoa2111437

Bi Y, Li M, Liu Y, et al. Intensive blood-pressure control in patients with type 2 diabetes. N Engl J Med. 2025;392(12):1155-1167. doi:10.1056/NEJMoa2412006

Jiao Y, Sun Z, Xie Y, et al. Potential impacts of the 2017 American College of Cardiology/American Heart Association high blood pressure guideline on Chinese adults and how to address them. BMC Cardiovasc Disord. 2020;20(1):237. doi:10.1186/s12872-020-01523-z

Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387(10022):957-967. doi:10.1016/S0140-6736(15)01225-8

Dong Y, Sun Z, Li Z, et al. Potential epidemiological impact of the 2017 American College of Cardiology/American Heart Association high blood pressure guideline on the Chinese population: a cross-sectional study in rural areas of Liaoning province. BMJ Open. 2020;10(9):e035900. doi:10.1136/bmjopen-2019-035900

Wang Q, Chao H, Zheng S, et al. Impact of new hypertension guidelines on target organ damage screening in a Shanghai community-dwelling population. J Clin Hypertens. 2019;21(10):1450-1455. doi:10.1111/jch.13677

Kario K. Global impact of 2017 American Heart Association/American College of Cardiology hypertension guidelines: a perspective from Japan. Circulation. 2018;137(6):543-545. doi:10.1161/CIRCULATIONAHA.117.032851

Muntner P, Carey RM, Gidding S, et al. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation. 2018;137(2):109-118. doi:10.1161/CIRCULATIONAHA.117.032582

Thai Hypertension Society. 2024 Thai Guidelines on the Treatment of Hypertension. Trick Think; 2024. Accessed 1 June 2026. https://thaihypertension.org/wp-content/uploads/2025/07/Guideline2024.pdf

Wang TD, Chiang CE, Chao TH, et al. 2022 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the management of hypertension. Acta Cardiol Sin. 2022;38(3):225-325. doi:10.6515/ACS.202205_38(3).20220321A