COMPARISON AND IMPLICATION OF THE CONTEMPORARY BLOOD PRESSURE GUIDELINES ON KOREAN POPULATION

Abstract

Objective: With continued effort to provide optimal prevention and management of high blood pressure (BP), we compared the potential impact on prevalence of hypertension, recommended antihypertensive treatment, and achievement of target BP according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) and the 2018 Korean Society of Hypertension (KSH) guidelines. Design and method: We analyzed the 2007–2017 Korea National Health and Nutrition Examination Survey data to calculate guideline-specific hypertension prevalence and treatment implications on adults aged 20 years or older by sex, age, and atherosclerotic cardiovascular disease risk. Results: The prevalence of hypertension was markedly higher 46.3% (95% confidence interval (CI) 45.6–46.9) by the ACC/AHA guideline due to the lowered BP cutoff than 25.9% (95% CI 25.4–26.5) by the KSH guideline; the increase was most pronounced in young adults. Yet, when incorporating age, atherosclerotic cardiovascular risk, comorbidity/target organ damage, there was only a marginal 1.6% (95% CI 0.9–3.0) increase in the percentage of adults who are suggested pharmacological approach by the ACC/AHA guideline, notably in the eldest subgroup. In addition, 45.6% (95% CI 44.4–46.8) of Korean adults currently undergoing antihypertensive treatment would fail to satisfy BP goal according to the 2018 KSH guideline, which would extend to 61.7% (95% CI 60.5–62.9) of participants according to the 2017 ACC/AHA guideline; the underachievement was contributed primarily by the younger subgroup. Conclusions: Despite a considerable increase in the prevalence of hypertension, the adoption of ACC/AHA guideline, regardless of sex and age, would leave modest percentage increase in adults recommended for antihypertensive medication and similar percentage of suggestions for nonpharmacological interventions, otherwise suggested also by the KSH guideline. Yet, in adherence to the ACC/AHA guideline, over half of the treated individuals would fail to achieve target BP especially in younger adults, thereby be laden with more intensive antihypertensive treatment. Despite accumulated evidence suggesting substantial cardiovascular risk reduction benefit with rigorous pharmacological approach, BP management should consider comprehensive aspects of the intended target. Future studies should assess differences in subclinical cardiovascular incidence and the benefits of long-term primary prevention of hypertension by various BP cutoffs.