Blood Pressure Control and Cardiovascular Outcomes: Real-world Implications of the 2017 ACC/AHA Hypertension Guideline

Lee, Ji Hyun; Kim, Sun Hwa; Kang, Si Hyuck; Cho, Jun Hwan; Cho, Youngjin; Oh, Il Young; Yoon, Chang Hwan; Lee, Hae Young; Youn, Tae Jin; Kim, Cheol Ho

doi:10.1038/s41598-018-31549-5

Cited by 48 publications

(42 citation statements)

References 28 publications

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“…While we reported an increase of over two folds, another study in Iran found an increase of about three folds from 12.6 to 42.7% from the fifth Table 4 Comparison of hypertension associated measures in males and females residents of Yazd Greater area according to JNC7 and ACC/AHA 2017 guidelines 2014-2015 phase (2012-2015) of the Tehran Lipid and Glucose Study [23]. An increase of 1.4 times from 31.9 to 45.6% in United States, [10] 1.6 times from 30.4 to 49.2% in Korea [24] and 1.9 times in Southwest China [25] was seen in different populations across the world.…”

Section: Discussionmentioning

confidence: 99%

Changes in the prevalence of measures associated with hypertension among Iranian adults according to classification by ACC/AHA guideline 2017

Mehrara

Mirzaei

et al. 2020

BMC Cardiovasc Disord

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Background: Different definitions have been proposed to categorize hypertension. We aimed to investigate the difference in prevalence of measures associated with hypertension according to the American College of Cardiology/American Heart Association (ACC/AHA) criteria versus Joint National Committee 7 (JNC7) criteria. Methods: We analyzed the data of 10,000 participants of Yazd Health Study (YaHS) aged 20-69 years. Blood pressure was measured three times with standard protocol defined by ACC/AHA. Prevalence of high blood pressure measure was compared in both definitions and absolute differences reported. Results: The prevalence of high blood pressure in our measurement was 61.0% according to ACC/AHA, and 28.9% according to JNC 7. The prevalence of self-reported hypertension was 18.6%. Age and sex standardized prevalence rates of high blood pressure measure indicates a 2.4-fold increase in the prevalence rate (30.1% absolute difference) by the ACC/AHA guideline. While the prevalence increased in all age groups, the age group of 20-29 showed the highest relative increase by 3.6 times (10.6% vs. 38.1%). High blood pressure measure among people with diabetes increased from 45.8 to 75.3% with the ACC/AHA guideline. Of the people who had no past history of diagnosed hypertension (n = 7887), 55.1 and 22.7% had high blood pressure measure by ACC/AHA and JNC-7 guidelines, respectively. From JNC7 to ACC/AHA, the overall difference in unawareness about HTN increased by 32.4%. Conclusion: Prevalence of hypertension associated measures increased over two folds by using the ACC/AHA criteria compared to JNC 7. Also, change in the criteria, reduces awareness of the disease and increases uncontrolled hypertension respectively. More research is needed to determine if the new definitions can affect management of hypertension in societies. Considering local priorities and implication of cost effective may improve implementation of new definitions for hypertension in different countries.

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Section: Discussionmentioning

confidence: 99%

Changes in the prevalence of measures associated with hypertension among Iranian adults according to classification by ACC/AHA guideline 2017

Mehrara

Mirzaei

et al. 2020

BMC Cardiovasc Disord

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“…Based on the 2017 ACC/AHA, a larger ratio of comorbid patients fell into the hypertensive category (24,15,17, and 11% more individuals with dyslipidaemia, high triglycerides, diabetes, and CVD events, respectively). Under this guideline, many high-risk adults might be covered by pharmacologic therapies and be protected against the progression of CVD and diabetic renal diseases [5,32].…”

Section: Discussionmentioning

confidence: 99%

Insight into blood pressure targets for universal coverage of hypertension services in Iran: the 2017 ACC/AHA versus JNC 8 hypertension guidelines

et al. 2020

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Background: We compared the prevalence, awareness, treatment, and control of hypertension in Iran based on two hypertension guidelines; the 2017 ACC/AHA-with an aggressive blood pressure target of 130/80 mmHg-and the commonly used JNC8 guideline cutoff of 140/90 mmHg. We shed light on the implications of the 2017 ACC/AHA for population subgroups and high-risk individuals who were eligible for non-pharmacologic and pharmacologic therapies. Methods: Data was obtained from the Iran national STEPS 2016 study. Participants included 27,738 adults aged ≥25 years as a representative sample of Iranians. Regression models of survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension. Results: The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) based on the 2017 ACC/AHA. The percentage of awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0), respectively, by applying the 2017 ACC/AHA. Based on the new guideline, adults aged 25-34 years had the largest increase in prevalence (from 7.3 to 30.7%). They also had the lowest awareness and treatment rate, contrary to the highest control rate (36.5%) between age groups. Compared with JNC8, based on the 2017 ACC/AHA, 24, 15, 17, and 11% more individuals with dyslipidaemia, high triglycerides, diabetes, and cardiovascular disease events, respectively, fell into the hypertensive category. Yet, based on the 2017 ACC/AHA, 68.2% of individuals falling into the hypertensive category were eligible for receiving pharmacologic therapy (versus 95.7% in JNC8). LDL cholesterol< 130 mg/dL, sufficient physical activity (Metabolic Equivalents≥600/week), and Body Mass Index were found to change blood pressure by − 3.56(− 4.38, − 2.74), − 2.04(− 2.58, − 1.50), and 0.48(0.42, 0.53) mmHg, respectively.

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“…It was also shown that more intensive BP lowering would be required for many adults taking antihypertensive medication. A previous study showed that there should be a similar impact if the 2017 ACC/AHA guidelines were directly applied to the Korean population [7].…”

Section: Introductionmentioning

confidence: 96%

Potential impact of 2018 Korean Society of Hypertension guidelines on Korean population: a population-based cohort study

et al. 2020

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Background: The Korean Society of Hypertension (KSH) revised the local guidelines for hypertension in 2018. The present study sought to evaluate the potential impact of the 2018 KSH guidelines on hypertension management status among the Korean population in terms of prevalence of hypertension, antihypertensive medical treatment recommendations, and control status in Korean adults. Methods: We used data from the Korea National Health and Nutrition Examination Survey to estimate the number and percentage of Korean adults who have hypertension according to blood pressure (BP) classification, are recommended to receive antihypertensive medical treatment, and are receiving medical treatment and have BP in the optimal range according to the new recommendations. Adults aged 30 years or older who participated in the survey between 2013 and 2015 were selected for this study. Results: The prevalence of hypertension was 30.5% among Korean adults aged 30 years or older. The percentage of subjects who are recommended to be treated with antihypertensive medications substantially increased from 32.5 to 37.8%, which translates to 1.6 million adults. Among the hypertensive patients who were receiving medical treatment, 38.6% were shown to have adequate BP levels as recommended by the 2018 KSH guidelines compared with 51.8% according to the previous 2013 guidelines. Conclusions: The present study reports the potential impact of the 2018 KSH guidelines on the prevalence of hypertension, antihypertensive medical treatment recommendations, and control status for Korean adults. The 2018 KSH guidelines recommend more intensive BP control compared with previous guidelines. This study suggests that there is large scope for improvement in hypertension management in the Korean population.

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Blood Pressure Control and Cardiovascular Outcomes: Real-world Implications of the 2017 ACC/AHA Hypertension Guideline

Cited by 48 publications

References 28 publications

Changes in the prevalence of measures associated with hypertension among Iranian adults according to classification by ACC/AHA guideline 2017

Changes in the prevalence of measures associated with hypertension among Iranian adults according to classification by ACC/AHA guideline 2017

Insight into blood pressure targets for universal coverage of hypertension services in Iran: the 2017 ACC/AHA versus JNC 8 hypertension guidelines

Potential impact of 2018 Korean Society of Hypertension guidelines on Korean population: a population-based cohort study

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