The Rates and the Determinants of Hypertension According to the 2017 Definition of Hypertension by ACC/AHA and 2014 Evidence-Based Guidelines Among Population Aged ≥40 Years Old

Wenzhen Li,Zhihong Wang,Shiyi Cao,Jing Ma,Chuanzhu Lv,Xiaojie Chen,Zuxun Lu,Dajie Chen,Feng Yan,Shijiao Yan,Yanhong Gong,Xiaojun Wang,Junan Liu,Jiafeng Chen,Fujian Song,Hui Li,Shuai Liu,Xiaoxv Yin,Wei Yue

doi:10.5334/gh.914

Abstract

Background:In November 2017, the American College of Cardiology/American Heart Association (ACC/AHA) updated their definition of hypertension from 140/90 mm Hg to 130/80 mm Hg.Objectives:We sought to assess the situation of hypertension and the impact of applying the new threshold to a geographically and ethnically diverse population.Methods:We analyzed selected data on 237,142 participants aged ≥40 who had blood pressure taken for the 2014 China National Stroke Screening and Prevention Project. Choropleth maps and logistic regression analyses were performed to estimate the prevalence, geographical distribution and risk factors of hypertension using both 2017 ACC/AHA guidelines and 2014 evidence-based guidelines.Results:The present cross-sectional study showed the age- and sex-standardized prevalence of hypertension was 37.08% and 58.52%, respectively, according to 2014 evidence-based guidelines and 2017 ACC/AHA guidelines. The distribution of hypertension and risk factors changed little between guidelines, with data showing a high prevalence of hypertension around Bohai Gulf and in south central coastal areas using either definition. The age- and sex-standardized prevalence of newly labeled as hypertensive was 21.44%. Interestingly, the high prevalence region of newly labeled as hypertensive was found in the north China.Conclusion:The prevalence of hypertension increased significantly on 2017 ACC/AHA guidelines compared to the prevalence when using 2014 evidence-based guidelines, with high prevalence areas of newly labeled as hypertensive now seen mainly in north China. There need to be correspondingly robust efforts to improve health education, health management, and behavioral and lifestyle interventions in the north.

Highlights

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines for the prevention, detection, evaluation, and management of high blood pressure (BP) in adults define hypertension as systolic blood pressure (SBP) ≥130 mmHg and diastolic blood pressure (DBP) ≥80 mmHg, replacing the previous threshold of 140/90 (SBP/DBP) mmHg as defined by 2014 evidence-based guidelines for managing high BP in adults developed by panel members appointed to the Eighth Joint National Committee (JNC 8) [1, 2]
The current change in the 2017 ACC/AHA guidelines was mainly based on epidemiological evidence, indicating that a lower threshold of 130/80 mmHg seemed reasonable as a cutoff for hypertension diagnosis and target BP for hypertension treatment [3, 4]
As previously described [14 15], China National Stroke Screening and Prevention Project (CNSSPP) focused on middle-aged and elderly population aged ≥40 years. It was conducted in 200 project areas within 30 provinces and municipalities in mainland China from October 2014 to November 2015 as part of a special project for healthcare reform established by the Ministry of Finance and National Health and Family Planning Commission

Summary

Introduction

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines for the prevention, detection, evaluation, and management of high blood pressure (BP) in adults define hypertension as systolic blood pressure (SBP) ≥130 mmHg and diastolic blood pressure (DBP) ≥80 mmHg, replacing the previous threshold of 140/90 (SBP/DBP) mmHg as defined by 2014 evidence-based guidelines for managing high BP in adults developed by panel members appointed to the Eighth Joint National Committee (JNC 8) [1, 2]. The new guidelines were based on the premise that strict BP lowering could maintain vascular health in early life and protect against cardiovascular disease (CVD) and organ damage later. From this perspective, the new guidelines are of great significance [5, 6]. The distribution of hypertension and risk factors changed little between guidelines, with data showing a high prevalence of hypertension around Bohai Gulf and in south central coastal areas using either definition. Conclusion: The prevalence of hypertension increased significantly on 2017 ACC/AHA guidelines compared to the prevalence when using 2014 evidence-based guidelines, with high prevalence areas of newly labeled as hypertensive seen mainly in north China.

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Discussion

Conclusion