Re-Classifying Hypertension in the Venezuelan EVESCAM Database Using 2017 AHA/ACC Criteria: High Prevalence, Poor Control, and Urgent Call for Action.

Juan González-Rivas,Maritza Duran,Jeffrey Mechanick,María Marulanda,Eunice Ugel,Ramfis Nieto-Martínez

doi:10.5334/aogh.2346

Abstract

Background:In 2017 the American Heart Association (AHA)/American College of Cardiology (ACC) changed the criteria to define hypertension (HTN).Objective:To re-analyze Venezuelan data to update HTN prevalence rates and estimate the number of adults with uncontrolled blood pressure (BP) using AHA/ACC criteria.Methods:The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3,420 adults from July 2014 to January 2017, with a response rate of 77.3%. The mean of two BP measurements was obtained using a standard oscillometric device protocol. HTN was defined using both 2017 AHA/ACC guideline (BP ≥ 130/80 mmHg) and JNC7 (BP ≥ 140/90 mmHg) criteria.Findings:The crude prevalence of HTN using 2017 AHA/ACC guideline criteria was 60.4%, 13% higher than with the JNC7 criteria. The age-standardized prevalence was 55.4% in men and 49.0% in women (p < 0.001), 17.5% and 12.7% higher, respectively, compared with the JNC7 criteria. In subjects without self-reported HTN, the age-standardized prevalence of HTN was 43.4% in men and 32.3% in women, of whom, 22.9% and 19.2% were between 130–139/80–89 mmHg, respectively. In those with self-reported HTN, the prevalence of uncontrolled BP (≥130/80 mmHg) on antihypertensive medication was 66.8% in men and 65.8% in women. The total estimated number of subjects with HTN in Venezuela increased to 11 million, and only about 1.8 million are controlled.Conclusion:Using the new 2017 AHA/ACC guideline, the prevalence of HTN in Venezuela is approximately half of the adult population and associated with relatively poor BP control.

Highlights

Hypertension (HTN) is the leading global burden modifiable risk factor, responsible for 211 million of DALYs (Disability-Adjusted Life Year) in 2015, followed by tobacco use and increased weight [1]
Blood pressure (BP) values over 115/75 mmHg expose a log-linear relationship with cardiovascular disease (CVD) [2]
Despite a linear relationship between blood pressure (BP) and CVD, HTN was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg primarily based on observational studies, and a cadre of randomized clinical trials [3]

Summary

Introduction

Hypertension (HTN) is the leading global burden modifiable risk factor, responsible for 211 million of DALYs (Disability-Adjusted Life Year) in 2015, followed by tobacco use and increased weight [1]. Sented by the American Heart Association (AHA) and the American College of Cardiology (ACC) redefines HTN diagnosis and subsequent BP target goals based on a 130/80 mmHg cutoff [4]. This conspicuous numerically based change is primarily based on the Systolic Blood Pressure Intervention Trial (SPRINT) [5], and supported by other relevant observational studies [2, 6, 7]. Conclusion: Using the new 2017 AHA/ACC guideline, the prevalence of HTN in Venezuela is approximately half of the adult population and associated with relatively poor BP control

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Conclusion