Abstract
The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines on hypertension management recommend new stage 1 hypertension thresholds (130-139/80-89 mmHg) for starting antihypertensive treatment. To analyze the impact of the 2017 ACC/AHA guidelines on patients' diagnoses within daily practice, in comparison with management using the 2018 European hypertension guidelines, regarding the new thresholds. Cross-sectional study conducted in a hypertension outpatient clinic at a tertiary-level public hospital. The diagnosis of hypertension was defined separately using each guideline. The participants were patients who were attending the hypertension clinic, who were evaluated using the thresholds of two guidelines, based on cardiovascular risk factors, including age, gender, smoking status, diabetes mellitus, dyslipidemia, obesity, osteoporosis, chronic renal failure and family history of hypertension. After adapting the guidelines to the blood pressure values of our sample, 74.5% (n = 277) of the patients were diagnosed as hypertensive according to the blood pressure classification of the European Society of Cardiology (ESC) guidelines published in 2018, while 91.1% (n = 339) of the patients were hypertensive according to the new 2017 ACC/AHA guidelines. Multivariate regression analysis revealed that the significant demographic and cardiovascular risk factors associated with hypertension, based on the 2018 European Society of Hypertension (ESH)/ESC guidelines, were age (odds ratio, OR: 1.027; 95% confidence interval, CI: 1.001-1.054; P = 0.042), obesity (OR: 4.534; 95% CI: 1.830-11.237; P = 0.001) and family history of hypertension (OR: 2.199; 95% CI: 1.252-3.862; P = 0.006). The factors associated with the definition of hypertension may vary through changing the threshold values.
Highlights
Hypertension is one of the leading public health problems in both developed and developing countries
Based on the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for blood pressure classification, 14.5% were in stage 1 and 76.6% were in stage 2 (Figure 1)
Using the definition of the 2018 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines, and comparing the patients with and without hypertension, we found that the patients in the hypertension group had more family history of hypertension (50.5%, n = 140 versus 35.8%, n = 34; P = 0.013)
Summary
Hypertension is one of the leading public health problems in both developed and developing countries. In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines for prevention, detection, evaluation and management of hypertension in adults. The new guidelines lower the threshold for the diagnosis of hypertension and target blood pressure levels of 130/80 mmHg in the general population. The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines on hypertension management recommend new stage 1 hypertension thresholds (130-139/8089 mmHg) for starting antihypertensive treatment. The participants were patients who were attending the hypertension clinic, who were evaluated using the thresholds of two guidelines, based on cardiovascular risk factors, including age, gender, smoking status, diabetes mellitus, dyslipidemia, obesity, osteoporosis, chronic renal failure and family history of hypertension. CONCLUSIONS: The factors associated with the definition of hypertension may vary through changing the threshold values
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