ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Pharmacoepidemiology
Impact of the 2017 ACC/AHA Hypertension Guidelines on Antihypertensive Prescribing in the United States: Real-World Evidence from a Nationally Representative Population
Provisionally accepted
- Jazan University College of Pharmacy, Jazan, Saudi Arabia
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Background: Hypertension (HTN) remains a major contributor to cardiovascular morbidity and mortality in the United States (US). The 2017 ACC/AHA HTN guidelines introduced major changes to diagnostic thresholds and treatment recommendations, including earlier pharmacological initiation and greater emphasis on combination therapy. However, the long-term, population-level impact of these guidelines on antihypertensive medication utilization in the US remains uncharacterized. Methods: We conducted a pooled cross-sectional study using data from the Medical Expenditure Panel Survey (2013-2022). Adults ≥18 years with diagnosed HTN were included. Antihypertensive classes utilization was defined as any use of the medication class with ≥2 prescription refills within the same year among eligible participants. Utilization of antihypertensive classes was then pooled and examined across two periods: pre-guidelines (2013–2017) and post-guidelines (2018–2022). Survey-weighted multivariable logistic regression models were used to assess the impact of the 2017 ACC/AHA guidelines on the overall utilization of antihypertensive drug classes and within subgroups with compelling indications. Results: A total of 29,901 adults were included. Following guidelines implementation, angiotensin receptor blockers (ARBs) utilization increased from 18% to 26% (adjusted OR [aOR] = 1.35; 95% confidence interval [CI]: 1.21–1.50, p < 0.0001), and calcium channel blocker (CCB) use increased from 28% to 32% (aOR = 1.24; 95% CI: 1.13–1.36, p < 0.0001). In contrast, fixed-dose combination (FDC) utilization declined from 22% to 16% (aOR = 0.67; 95% CI: 0.59–0.75, p < 0.0001). Utilization of other antihypertensive classes did not change significantly. Conclusions: After the 2017 ACC/AHA guidelines update, antihypertensive prescribing in the US showed increased use of ARBs and CCBs. However, declining FDC use highlights a persistent gap between evidence-based guidance and real-world practice.
Keywords: 2017 ACC/AHA hypertension guidelines, Antihypertensive, fixed-dose combination antihypertensives, Hypertension, prescribing
Received: 14 Jan 2026; Accepted: 12 Feb 2026.
Copyright: © 2026 Jafari. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Eissa A. Jafari
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