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

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

doi:10.1038/s41598-018-31549-5

Abstract

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline lowered the threshold defining hypertension and treatment target from 140/90 mmHg to 130/80 mmHg. We compared the 2017 ACC/AHA guideline and the Eighth Joint National Committee (JNC8) report with regard to the current status of hypertension using the Korean National Health and Nutrition Examination Survey. The association between blood pressure (BP) control and long-term major cardiovascular outcomes (MACEs) was analyzed using the Korea National Health Insurance Service cohort. In the cross-sectional study with 15,784 adults, the prevalence of hypertension was expected to be 49.2 ± 0.6% based on the definition suggested by the 2017 ACC/AHA guideline versus 30.4 ± 0.6% based on the JNC8 report. In a longitudinal analysis with 373,800 hypertensive adults for the median follow-up periods of 11.0 years, the adults meeting the target goal BP goal of 2017 ACC/AHA guideline were associated with 21% reduced risk of MACEs compared with adults, not meeting 2017 ACC/AHA BP goal but meeting JNC8 target goal. In conclusion, substantial increase of prevalence of hypertension is expected by the 2017 ACC/AHA guideline. This study also suggests endorsing the aggressive approach would lead to an improvement in cardiovascular care.

Highlights

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline lowered the threshold defining hypertension and treatment target from 140/90 mmHg to 130/80 mmHg
The prevalence of hypertension was estimated to be 49.2% based on the blood pressure (BP) criteria suggested by the 2017 American College of Cardiology/ American Heart Association (ACC/AHA) guidelines, which was a significant increase compared to the 30.4% prevalence rate based on the previous definitions (Fig. 1)
The risk profiles of the 5.6 million subjects (18.8% of adults) who were newly classified as having stage 1 hypertension based on the 2017 ACC/AHA guidelines were between those of stage 2 hypertension and normal BP groups

Summary

Introduction

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline lowered the threshold defining hypertension and treatment target from 140/90 mmHg to 130/80 mmHg. We compared the 2017 ACC/AHA guideline and the Eighth Joint National Committee (JNC8) report with regard to the current status of hypertension using the Korean National Health and Nutrition Examination Survey. In the cross-sectional study with 15,784 adults, the prevalence of hypertension was expected to be 49.2 ± 0.6% based on the definition suggested by the 2017 ACC/AHA guideline versus 30.4 ± 0.6% based on the JNC8 report. Every 20 mmHg systolic or 10 mmHg diastolic BP increase above the threshold has shown to double the risk of mortality from ischemic heart disease and stroke[5]. The newly released 2017 American College of Cardiology/ American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults supports a more aggressive diagnostic and treatment approach[10]. How many people would be classified as having hypertension, how many among them would be recommended pharmacologic treatment, and whether more aggressive BP goals would lead to better cardiovascular outcomes

Methods

Results

Conclusion