Prevalence of ambulatory blood pressure phenotypes using the 2017 American College of Cardiology/American Heart Association blood pressure guideline thresholds: data from the Coronary Artery Risk Development in Young Adults study.

Abstract

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline lowered the BP thresholds for defining hypertension compared with the Seventh Report of the Joint National Committee (JNC7) guideline. We analyzed clinic and ambulatory BP monitoring data from 717 Coronary Artery Risk Development in Young Adults study participants and compared the prevalence of clinic and out-of-clinic BP phenotypes using thresholds from the 2017 ACC/AHA and JNC7 guidelines. Among participants not taking antihypertensive medication and according to the JNC7 and 2017 ACC/AHA guidelines, 11.1 and 30.1% of participants had clinic hypertension, 37.5 and 57.9% had awake hypertension, 35.7 and 58.1% had asleep hypertension, and 35.7 and 58.6% had 24-h hypertension, respectively. According to the JNC7 and 2017 ACC/AHA guideline definitions, 1.9 and 3.2% had white-coat hypertension, 28.2 and 31.0% had masked hypertension and 9.3 and 26.9% had sustained hypertension, respectively. Among participants taking antihypertensive medication and when defined using the JNC7 and 2017 ACC/AHA guideline BP thresholds, 18.6 and 45.3% had uncontrolled clinic BP, 48.1 and 62.5% had uncontrolled awake BP, 48.1 and 70.2% had uncontrolled asleep BP and, 47.7 and 65.3% had uncontrolled 24-h BP, respectively. Using JNC7 and 2017 ACC/AHA guideline BP thresholds, the prevalence was 1.4 and 5.2% for white-coat effect, 30.9 and 22.5% for masked uncontrolled hypertension, and 17.2 and 40.0% for sustained uncontrolled BP, respectively. The 2017 ACC/AHA guideline results in a substantially higher prevalence of awake, asleep, 24-h, and sustained hypertension.