Impact of 2017 ACC/AHA guideline on prevalence, awareness, treatment, control, and determinants of hypertension: a population-based cross-sectional study in southwest of Iran

Abstract

Background In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) provided a new guideline for hypertension prevention and management. We aimed to update the prevalence, awareness, control, and determinants of hypertension based on this guideline in Khuzestan province, southwest of Iran, and to estimate the number of people who are eligible for non-pharmacologic and pharmacologic intervention. Methods This population-based cross-sectional study was conducted in Khuzestan, a large province in the southwest of Iran. Comprehensive information about the potential relating factors of hypertension was collected, blood pressure was measured, and anthropometric measurements were obtained. Moreover, the dietary pattern was evaluated in 2830 individuals, using a qualitative food frequency questionnaire. Results Among 30,506 participants, 30,424 individuals aged 20–65 years were eligible for the study. In comparison with the previous guideline released by the Joint National Committee (JNC8), the prevalence of hypertension in Khuzestan dramatically increased from 15.81 to 42.85% after implementation of the ACC/AHA guideline, which was more dominant in the male population and the 45–54 age group. The sex and age adjustment of the hypertension prevalence was estimated to be 39.40%. The percentage of hypertension awareness, treatment, and control were 45.85%, 35.42%, and 59.63%, which dropped to 22.72%, 26.37%, and 28.94% after implementation of new guideline, respectively. Conclusions In the ACC/AHA guideline, a higher number of individuals with the pre-hypertension condition were shifted into the hypertension category and the level of awareness, treatment, and control were dramatically decreased, which highlight a great need to expand the public health infrastructure for further managing the substantial increased burden on healthcare system. However, further studies with population over 65 years are required to estimate the eligibility for antihypertensive treatment in this province after implementation of new guideline.

Trends of Hypertension Stages among Iranian Adults from 2005 to 2025 using WHO STEPS studies: A Comparison among 2017 ACC/AHA, JNC7, and 2020 ISH Guidelines

“…Another study across 16 Iranian provinces projected an increase in age-sex standardized prevalence from 22.3-36.5% 20 . In Tehran 22 , Yazd 23 , and Khuzestan 24 , hypertension prevalence was estimated to change from 20.4-47.1%, 28.9-61.0%, and dramatically from 15.81-42.85% with ACC/AHA adoption instead of JNC7. Internationally, adopting the ACC/AHA guideline in China doubled hypertension prevalence 25 , and also showed a steeper trend, while Brazil experienced a 2.6-fold increase, from 21.1-54.7% 26 .…”

“…Lifestyle modi cations are recommended before reaching these thresholds. Therefore, the transition from JNC7 to ACC/AHA is expected to have a limited impact on medication prescriptions, as previous studies in Iran demonstrated only marginal increases of about 21.18% 24 and 30% 21 after the shift, resulting in only slightly higher costs for the health system. However, in other countries such as the US and China, this change was associated with signi cantly higher costs 14 .…”

Correction to: Impact of 2017 ACC/AHA guideline on prevalence, awareness, treatment, control, and determinants of hypertension: a population-based cross-sectional study in southwest of Iran

“…Following the publication of the original article [ 1 ], the authors reported a missing grant number in their Funding declaration. The updated Funding declaration is as follows:…”

Global Impact of Different Blood Pressure Thresholds in 4 021 690 Participants of the May Measurement Month Initiative

“…A number of studies have looked into the epidemiological consequences of changing the definitions from ≥140/90 to ≥130/80 mm Hg to define hypertension in specific regions or countries, including the United States, 14,15 China, 15 Australia, 16 Iran, 17 and Saudi Arabia 18 among others. However, some of these reports are limited to narrow age ranges or specific ethnic groups, which reduces comparability.…”