SUN-228 ACC/AHA BLOOD PRESSURE THRESHOLD AND BURDEN OF HYPERTENSION, AND PREVENTING CHRONIC KIDNEY DISEASE

Abstract

The diagnosis and treatment of hypertension with the appropriate agents to the desirable BP goal is arguably one of the most cost effective interventions in modern medicine. What constitutes the appropriate BP treatment goal is based on the available evidence that the attainment of such BP levels should limit or altogether prevent the complications such as CKD due to hypertensive nephrosclerosis. Recently the AHA/ACA recommended a downward review of the BP threshold compared to the JNC 7 recommendations for diagnosis of hypertension. In this cross sectional survey of the general population in the Northeast, Nigeria, we recruited all the adults who responded to our invitation for medical check in clusters of residential areas in the Maiduguri and its environs. Besides the documentation of the demographic characteristics, we recorded three consecutive blood pressure measurements of all adults aged 18 and above and determined the average of both the systolic (SBP) and diastolic (DBP) blood pressures. We further categorized the study population into BPs groups according to the JNC7 cut off value of SBP >/=140 and or DBP of >/=90mmHg for stage 1 hypertension and by the 2017 ACC/AHA threshold of >/=130 and/or >/=80 mmHg. Nigeria in 2017 had a median age of 18.4 years and an estimated population of 197.7 million people. 1010 adults aged 18 to 79 (mean 36.7) years made up of 544 males and 466 females (M:F = 1.2:1) were studied. The prevalence of hypertension by the JNC 7 threshold was 344/1010 (34%) plus an additional 138 (13.6%) individuals classified as having hypertension by the AHA/ACA threshold. Therefore 47.6% of the adult population are at risk of developing complications of hypertension in Nigeria. The mean eGFR for the general study population was 100.5ml/min/1.73M2. The SBP categories 130-139mmHg and the >/= 140mmHg had eGFRs of 98.6 and 98.5 ml/min/1.73M2 respectively. On the other hand SBP categories less than 120mmHg and the 120-9 mmHg had eGFRs of 103 and 102.0ml/min/1.73M2 respectively. Those eGFR values were higher than eGFRs of the study population as a whole and those of the individuals with higher SBPs than 130mmHg. The individuals with DBP categories < 80 and 80 - 89mmHg had eGFRs of 101.5 and 101.6 which were higher than the 97.4ml/mi/1.74M2 for the individuals with DBP greater than 90mmHg. Based on the ACC/AHA guideline on hypertension, close to half of the adults in the general population amounting to about 50 million Nigerians are at the risk of developing the consequences of hypertension. Moreover the blood pressure categories of SBP less than 130mmHg and/or DBP less than 90mmHg had kidney functions which were better than the average for the study population and those of individuals with higher BP measurements. Our study lends support to the ACC/AHA report that some health risk including the possible loss of kidney function maybe associated with SBP greater than 130mmHg in the general population.