Dataset Information

Change in blood pressure status defined by 2017 ACC/AHA hypertension guideline and risk of cardiovascular disease: results of over a decade of follow-up of the Iranian population.

ABSTRACT:

Background

Hypertension (HTN) is known to be the leading cause of cardiovascular disease (CVD) and mortality. We aimed to assess the impact of changes in 3 years in different blood pressure (BP) categories on incident CVD.

Methods

In this study, 3,685 Tehranians aged ≥30 years (42.2% men) free of prevalent CVD with BP level <140/90 mmHg and not on BP-lowering medications were enrolled. Participants were grouped according to baseline BP category using the 2017 ACC/AHA hypertension guideline definition: normal BP (<120/80 mmHg), elevated BP (120-129/<80), and stage 1 HTN (130-139 and/or 80-89). The hazard ratio of incident CVD by changes in the BP category was estimated after adjustment for traditional risk factors using Cox's proportional hazard model, with stable normotension as a reference.

Results

During a median follow-up of 11.7 years, 346 CVD events (men = 208) occurred. Compared to the reference group, among participants with normal BP at baseline, only those with BP rising to stage 1 HTN [1.47 (0.99-2.16)], and among those with stage 1 HTN at baseline, regression to elevated BP [1.80 (1.11-2.91)], remaining at stage 1 [1.80 (1.29-2.52)], and progression to stage 2 HTN [1.81 (1.25-2.61)] had a higher risk for CVD; however, regression to normal BP attenuated this risk [1.36 (0.88-2.12)]. Conversion from elevated BP to any other categories had no significant association with CVD risk.

Conclusions

Generally, prevalent stage 1 HTN (regardless of changing category) and incident stage 1 HTN were significantly associated with a higher risk of CVD; even regression to elevated BP did not attenuate the risk. Accordingly, these populations are potential candidates for antihypertensive management.

SUBMITTER: Kabootari M

PROVIDER: S-EPMC10288986 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Change in blood pressure status defined by 2017 ACC/AHA hypertension guideline and risk of cardiovascular disease: results of over a decade of follow-up of the Iranian population.

Kabootari Maryam M Tamehri Zadeh Seyed Saeed SS Hasheminia Mitra M Azizi Fereidoun F Hadaegh Farzad F

Frontiers in cardiovascular medicine 20230609

<h4>Background</h4>Hypertension (HTN) is known to be the leading cause of cardiovascular disease (CVD) and mortality. We aimed to assess the impact of changes in 3 years in different blood pressure (BP) categories on incident CVD.<h4>Methods</h4>In this study, 3,685 Tehranians aged ≥30 years (42.2% men) free of prevalent CVD with BP level <140/90 mmHg and not on BP-lowering medications were enrolled. Participants were grouped according to baseline BP category using the 2017 ACC/AHA hypertension ...[more]

PMID: 37363089

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Project description:ImportanceIn the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline, the definition of hypertension was lowered from a blood pressure (BP) of greater than or equal to 140/90 to greater than or equal to 130/80 mm Hg. The new diastolic BP threshold of 80 mm Hg was recommended based on expert opinion and changes the definition of isolated diastolic hypertension (IDH).ObjectiveTo compare the prevalence of IDH in the United States, by 2017 ACC/AHA and 2003 Joint National Committee (JNC7) definitions, and to characterize cross-sectional and longitudinal associations of IDH with outcomes.Design, setting, and participantsCross-sectional analyses of the National Health and Nutrition Examination Survey (NHANES 2013-2016) and longitudinal analyses of the Atherosclerosis Risk in Communities (ARIC) Study (baseline 1990-1992, with follow-up through December 31, 2017). Longitudinal results were validated in 2 external cohorts: (1) the NHANES III (1988-1994) and NHANES 1999-2014 and (2) the Give Us a Clue to Cancer and Heart Disease (CLUE) II cohort (baseline 1989).ExposuresIDH, by 2017 ACC/AHA (systolic BP <130 mm Hg, diastolic BP ≥80 mm Hg) and by JNC7 (systolic BP <140 mm Hg, diastolic BP ≥90 mm Hg) definitions.Main outcomes and measuresWeighted estimates for prevalence of IDH in US adults and prevalence of US adults recommended BP pharmacotherapy by the 2017 ACC/AHA guideline based solely on the presence of IDH. Risk of incident atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD) in the ARIC Study.ResultsThe study population included 9590 adults from the NHANES (mean [SD] baseline age, 49.6 [17.6] years; 5016 women [52.3%]) and 8703 adults from the ARIC Study (mean [SD] baseline age, 56.0 [5.6] years; 4977 women [57.2%]). The estimated prevalence of IDH in the NHANES was 6.5% by the 2017 ACC/AHA definition and 1.3% by the JNC7 definition (absolute difference, 5.2% [95% CI, 4.7%-5.7%]). Among those newly classified as having IDH, an estimated 0.6% (95% CI, 0.5%-0.6%) also met the guideline threshold for antihypertensive therapy. Compared with normotensive ARIC participants, IDH by the 2017 ACC/AHA definition was not significantly associated with incident ASCVD (n = 1386 events; median follow-up, 25.2 years; hazard ratio [HR], 1.06 [95% CI, 0.89-1.26]), HF (n = 1396 events; HR, 0.91 [95% CI, 0.76-1.09]), or CKD (n = 2433 events; HR, 0.98 [95% CI, 0.65-1.11]). Results were also null for cardiovascular mortality in the 2 external cohorts (eg, HRs of IDH by the 2017 ACC/AHA definition were 1.17 [95% CI, 0.87-1.56] in the NHANES [n = 1012 events] and 1.02 [95% CI, 0.92-1.14] in CLUE II [n = 1497 events]).Conclusions and relevanceIn this analysis of US adults, the estimated prevalence of IDH was more common when defined by the 2017 ACC/AHA BP guideline compared with the JNC7 guideline. However, IDH was not significantly associated with increased risk for cardiovascular outcomes.

Project description:ImportanceThe 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults lowered the systolic and diastolic blood pressure thresholds for hypertension to 130 and 80 mm Hg, respectively. This represents a reduction of 10 mm Hg in both systolic and diastolic blood pressure levels used to define hypertension compared with previous guidelines, such as the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).ObjectivesTo estimate the prevalence of hypertension among adults aged 18 years or older in Nepal per the 2017 ACC/AHA guideline and to determine the absolute difference in hypertension prevalence comparing the 2017 ACC/AHA and JNC 7 guidelines.Design, setting, and participantsThe cross-sectional analysis used data from the population-based 2016 Nepal Demographic and Health Survey. Data were collected from June 2016 to January 2017 using a multistage stratified sampling procedure that was applied in urban and rural areas, using wards as the primary sampling units. Individuals aged 15 years or older from selected households were interviewed. The survey had an overall response rate of approximately 97%.Main outcomes and measuresThe primary outcome was the prevalence of hypertension. Blood pressure was measured 3 times for each participant with 5-minute intervals between. Hypertension was present if blood pressure was greater than or equal to 130/80 mm Hg for the 2017 ACC/AHA guideline, and greater than or equal to 140/90 mm Hg for the JNC 7 guideline.ResultsAmong 13 519 participants (median [interquartile range] age, 38 [26-53] years; 7821 [57.9%] female), 44.2% (95% CI, 43.4%-45.0%; n = 5977) had hypertension according to the 2017 ACC/AHA guideline compared with 21.2% (95% CI, 20.5%-21.9%; n = 2869) by the JNC 7 guideline. The new prevalence was associated with an absolute increase of 23.0% (95% CI, 22.3%-23.7%) from the JNC 7 guideline. When estimating the proportion of hypertension by background characteristics, the new 2017 ACC/AHA guideline definition increased the prevalence to 50% or greater for some categories, with the highest prevalence among those with a body mass index (calculated as weight in kilograms divided by height in meters squared) greater than or equal to 30 (71.6%; 95% CI, 67.7%-75.3%) and between 25 and 29.9 (62.1%; 95% CI, 60.1%-64.1%).Conclusions and relevanceFor adults in Nepal, the new 2017 ACC/AHA guideline reveals a greater estimated prevalence of hypertension compared with the JNC 7 guideline. Because of the public health significance of hypertension, higher prevalence rates confirm the importance of developing effective prevention and control methods in this country.

Dataset Information

Change in blood pressure status defined by 2017 ACC/AHA hypertension guideline and risk of cardiovascular disease: results of over a decade of follow-up of the Iranian population.

Background

Methods

Results

Conclusions

Publications

Change in blood pressure status defined by 2017 ACC/AHA hypertension guideline and risk of cardiovascular disease: results of over a decade of follow-up of the Iranian population.

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