Blood Pressure Guidelines Research Articles

Age-specific in the relationship between diastolic blood pressure and the risk of cardiovascular disease: A cohort study of the UK Biobank.

To investigate the effect of optimal diastolic blood pressure (DBP) level on cardiovascular disease (CVD) events, considering different age groups. And the nonlinear relationship between DBP and CVD events by age were evaluated. 358,734 participants of the UK biobank were included. Multivariable Cox regressions were performed to evaluate the relation between DBP and cardiovascular risk, and the natural cubic spline was applied to estimate the nonlinear relationship between the DBP measures and the hazard. In the UK Biobank, a total of 358,734 participants (mean [SD] age, 55.3 [8.1] years; 205,215 [57.2 %] female) were included in this analysis. The rate of CVD cases was 6.05 per 1000 person-years. For each SD increase, DBP was associated with elevated CVD events for both <50 year (HR, 1.19; 95 % CI, 1.12 to 1.26) and 50-59 year-old group (HR, 1.04; 95 % CI, 1.01 to 1.08). However, for every SD increment, a marginal protective effect against CVD events was observed between DBP and the CVD events in elder people (≥60 years old) and lower DBP (<70 mm Hg) may confer an increased CVD risks (HR, 1.10; 95 % CI, 1.03 to 1.17). For adults younger than 60 years old, the study seems to support the ACC/AHA blood pressure guidelines lowering the DBP threshold to 80 mm Hg. Conversely, it may be reasonable to rule out large effects of high DBP on CVD events and DBP <70 mm Hg may be cause for caution in older people aged 60-69.

The impact of blood pressure guidelines on the cardiovascular event risk in Japanese patients with coronary artery disease in a real-world database using a multimodal data acquisition system

Abstract Background The European Society of Hypertension and the Japanese Society of Hypertension have established a blood pressure (BP) guideline for coronary artery disease (CAD): 130/80 mmHg. The impact of adhering to this BP guideline on the prognosis of Japanese patients with CAD after they have undergone percutaneous coronary intervention (PCI) is unclear. Purpose We investigated the impact of the current guideline-recommended BP value 130/80 mmHg on the prognosis of Japanese patients with CAD by using 'big data,' i.e., the Clinical Deep Data Accumulation System (CLIDAS) database. Methods We evaluated the data of 8,793 CAD patients who underwent cardiac catheterization at six university hospitals and Japan's National Cerebral and Cardiovascular Center (mean ± std. dev. 70 ± 11 years, 78% male, 43% with acute coronary syndrome [ACS]). We categorized the patients based on their BP management: those adhering to the guideline-recommended BP (&amp;lt;130/80 mmHg) and those under stricter BP control criteria (&amp;lt;120/70 mmHg and &amp;lt;110/60 mmHg). We compared the incidence of major adverse cardiovascular events (MACCEs) between these groups, with MACCEs being a composite endpoint (cardiovascular death, stroke, and myocardial infarction). We analyzed the relationship between BP classification and MACCE separately in two groups: the patients with ACS and those with chronic coronary syndrome (CCS). Results During an average follow-up period of 33 months, 710 MACCEs occurred, comprising 234 cardiovascular deaths, 305 strokes, and 270 myocardial infarctions, with some cases overlapping. No significant difference in the MACCE rate was observed between the group with BP below 130/80 mmHg and the group with BP above 130/80 mmHg (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.75–1.04, p=0.133). In the ACS group, the patients maintaining BP below 130/80 mmHg had a significantly lower MACCE incidence (HR 0.75, 95%CI: 0.59–0.95, p=0.017) and a significantly lower incidence of stroke (HR 0.47, 95%CI: 0.33–0.68, p&amp;lt;0.001), whereas no significant difference in the MACCE incidence was observed in the CCS group (HR 0.91, 95%CI: 0.73–1.13, p=0.393). Blood pressure values below 120/70 mmHg (HR 1.13, 95%CI: 0.97–1.31, p=0.109) and 110/60 mmHg (HR 1.23, 95%CI: 1.06–1.43, p=0.008), corresponded to an increased rate of MACCEs, becoming more pronounced at BP values &amp;lt;110/60 mmHg. Conclusion Achieving the BP guideline target of &amp;lt;130/80 mmHg is associated with improved outcomes in CAD patients, particularly regarding reducing the risk of stroke among patients with ACS. However, BP control at values that are too low may potentially worsen the prognosis for CAD patients.Kaplan–Meier curve

Social determinants of health, blood pressure classification, and incident stroke in community-dwelling adults: a prospective cohort study

Abstract Objective To determine whether the association of blood pressure (BP) categories, defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline, with stroke differ among Chinese adults with low or high burden of unfavorable social determinants of health (SDOH). Design and Methods: Analyses were conducted in the prospective sub-cohort of the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, started in 1, July 2017 and followed stroke events until 31, June 2023. Participants were divided into groups with low and high burden of unfavorable SDOH, which consisted of educational attainment, economic stability, health care access, social support, and neighborhood relationship. Within each group, participants were categorized as having normal BP (systolic BP [SBP] &amp;lt;120 mm Hg and diastolic BP [DBP] &amp;lt;80 mm Hg), elevated BP (SBP 120-129 mm Hg and DBP &amp;lt;80 mm Hg), stage 1 hypertension (SBP 130-139 mm Hg or DBP 80-89 mm Hg), and stage 2 hypertension (SBP ≥140 mm Hg or DBP ≥90mm Hg). The association between BP categories and stroke risk were examined within each SDOH group, separately, using multivariable-adjusted Cox proportional hazards models. Results Of the 96,686 adults included in this study (mean [SD] age, 53.8 [10.1] years; 59,080 [61.1%] women), 64,823 (67.0%) were categorized as having high burden of unfavorable SDOH. Over a median follow-up of 5.0 years, 4,673 (4.8%) incident stroke events occurred. In the group of low burden of SDOH, hazard ratios (95% CI) for stroke events for elevated BP, stage 1 hypertension, and stage 2 hypertension vs normal BP were 1.09 (0.86-1.37), 1.14 (0.94-1.37), and 1.59 (1.33-1.90), respectively. In the group of high burden of SDOH, hazard ratios for stroke events for elevated BP, stage 1 hypertension, and stage 2 hypertension vs normal BP were 1.20 (1.04-1.38), 1.45 (1.29-1.62), and 1.71 (1.53-1.91), respectively. Results were similar after excluding those taking antihypertensive medications. Conclusion Lower BP categories were closely associated with increased risk of stroke in the context of high burden of SDOH. Early counseling and surveillance of high BP should be emphasized within socioeconomically disadvantaged populations.

Arm Position and Blood Pressure Readings

Guidelines for blood pressure (BP) measurement recommend arm support on a desk with the midcuff positioned at heart level. Still, nonstandard positions are used in clinical practice (eg, with arm resting on the lap or unsupported on the side). To determine the effect of different arm positions on BP readings. This crossover randomized clinical trial recruited adults between the ages of 18 and 80 years in Baltimore, Maryland, from August 9, 2022, to June 1, 2023. Participants were randomly assigned to sets of triplicate BP measurements with the arm positioned in 3 ways: (1) supported on a desk (desk 1; reference), (2) hand supported on lap (lap), and (3) arm unsupported at the side (side). To account for intrinsic BP variability, all participants underwent a fourth set of BP measurements with the arm supported on a desk (desk 2). The primary outcomes were the difference in differences in mean systolic BP (SBP) and diastolic BP (DBP) between the reference BP (desk 1) and the 2 arm support positions (lap and side): (lap or side - desk 1) - (desk 2 - desk 1). Results were also stratified by hypertensive status, age, obesity status, and access to health care within the past year. The trial enrolled 133 participants (mean [SD] age, 57 [17] years; 70 [53%] female); 48 participants (36%) had SBP of 130 mm Hg or higher, and 55 participants (41%) had a body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 or higher. Lap and side positions resulted in statistically significant higher BP readings than desk positions, with the difference in differences as follows: lap, SBP Δ 3.9 (95% CI, 2.5-5.2) mm Hg and DBP Δ 4.0 (95% CI, 3.1-5.0) mm Hg; and side, SBP Δ 6.5 (95% CI, 5.1-7.9) mm Hg and DBP Δ 4.4 (95% CI, 3.4-5.4) mm Hg. The patterns were generally consistent across subgroups. This crossover randomized clinical trial showed that commonly used arm positions (lap or side) resulted in substantial overestimation of BP readings and may lead to misdiagnosis and overestimation of hypertension. ClinicalTrials.gov Identifier: NCT05372328.

Updated Blood Pressure Guidelines: Navigating Workplace Impact.

Updated Blood Pressure Guidelines: Navigating Workplace Impact.

What is New in the ESC Hypertension Guideline?

Blood pressure guidelines serve as a beacon of best practice for the diagnosis and management of hypertension. The many cultural and societal differences in hypertension risk factors and management patterns across geographic regions support the need for geographically distinct international guidelines. In 2018, the European Society of Cardiology (ESC) and European Society of Hypertension (ESH) released a joint guideline for the management of hypertension.1 This guideline represented a unified front across European hypertension-oriented societies. Similar to preceding hypertension guidelines, the 2018 guideline highlighted the myriad risks associated with inadequate blood pressure management and the importance of improving blood pressure control. The 2018 ESC/ESH guideline also offered a litany of nuanced recommendations on blood pressure measurement and management, including tiered blood pressure diagnosis and management thresholds across various ages and risk factors. For example, the guidelines recommended initiating antihypertensive therapy at a systolic blood pressure threshold of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg in individuals aged 18-79 years, and at a systolic blood pressure threshold of ≥160 mm Hg in individuals aged ≥80 years; treatment initiation could be considered at a blood pressure of ≥130/85 among individuals with established cardiovascular disease. Among individuals being treated for hypertension, the guideline recommended aiming for an initial blood pressure goal of <140/90 mm Hg in all individuals, and if tolerated, further aiming for a systolic blood pressure of 120-129 mm Hg in most individuals aged <65 years and considering a diastolic blood pressure of <80 mm Hg in all individuals. In contrast, contemporary to these guidelines, the 2017 American College of Cardiology/American Heart Association guidelines more broadly recommended stringent blood pressure diagnostic thresholds (≥140/90 mm Hg in lower risk individuals; ≥130/80 mm Hg in higher risk individuals including those with ≥10% 10-year risk of atherosclerotic cardiovascular disease) and management goals (<130/80 mm Hg in all individuals with hypertension). Thus, the 2018 ESC/ESH guideline focused much more on individualized goals. [See the full article for more].

P151 RECOMMENDATIONS FOR HOME BLOOD PRESSURE MEASUREMENT ARE INCONSISTENT BETWEEN INTERNATIONAL GUIDELINES

Background and objective. Recommendations made across blood pressure (BP) guidelines should use consistent messaging to inform patient education for home BP measurement. It is not known if recommendations for home BP measurement are consistent across BP guidelines, which was the aim of this study. Methods. Recommendations for home BP measurement were extracted verbatim from six BP guidelines and expert consensus statements (Australian, United States, Canadian, European, International and Japanese). Consistency between BP guidelines was assessed by head-to-head comparison of recommendations and classified as inconsistent if the recommendation was not differed from one or more other recommendation. Analysis was conducted independently by two investigators (EC, KS) and conflicts adjudicated by two other investigators (NC, DP). Results. In total, 101 recommendations for home BP measurement were identified, and each guideline contained a median of 33 recommendations. Forty-four recommendations (44%) were present in two or more of the six guidelines. The only recommendation made by all six guidelines was to measure BP in a seated position. Forty-nine recommendations (49%) were inconsistent with at least one other recommendation. Twenty-nine of these recommendations (59%) contained a time parameter such as how many days to measure BP at home and how long to abstain from caffeine or tobacco usage prior to measurement. All recommendations on choosing and fitting a BP cuff were inconsistent, except the recommendations to fit the cuff to a bare arm and choose an appropriately sized cuff. Conclusion. There is a lack of consistency in the recommendations made for home BP measurement by international guidelines. Harmonisation across BP guidelines is needed to create clear, unambiguous messaging in guideline recommendations to support implementation of evidence-based care for home BP measurement and management.

Abstract 17: First-Line Beta Blocker Use Among &gt;3.1 Million Veterans Initiating Hypertension Treatment, 2000-2022

Introduction: It is unknown how often beta blockers (BB) are used first line for high blood pressure (BP) treatment among patients without compelling indications, despite US BP guidelines not recommending this practice since 2014. Research Question: How many start, and what factors influence, first line BB use among patients without compelling indications? Methods: Serial cross-sectional study of outpatients newly diagnosed and initiating treatment in the Veterans Health Administration, 1/1/2000–12/31/2022. We removed prevalent users, categorized drugs by class, and presented compelling indication status by initial BB use (mono- or combination therapy). Among those without compelling indications (ie, aortic aneurysm/disease, angina, atrial fibrillation/tachyarrhythmia, chronic liver disease/cirrhosis, heart failure with reduced ejection fraction, myocardial infarction, or coronary revascularization), multivariable Poisson regression estimated factors associated with BB use. Results: Of 3138304 Veterans (mean age 61 years, 94% male, 65% Non-Hispanic White), 774821 (25%) initiated a BB, of which the proportion without compelling indications decreased over time from 91% to 81%; the proportion with compelling indications increased from 9% to 19% (Panel A). Specific BBs used changed over time (Panel B). Among those without compelling indications, BB initiation was more likely with increasing age, females, current smokers, alcohol abuse, aspirin or statin use, each additional antihypertensive prescribed, each pre-index hospitalization, and urban setting (Panel C). Conclusions: Most Veterans using BB first line for high BP do not have compelling indications. Interventions are needed to align real world treatments with guidelines.

Abstract P117: Provider Concordance to the Current 2017 High Blood Pressure (BP) Clinical Practice Guidelines and Patient Blood Pressure Control

Introduction: The AHA/ACC 2017 High BP guidelines introduced key changes, compared to previous guidelines, including a new hypertension definition (≥130/80 mm Hg) and lower medication thresholds for patients at cardiovascular risk. The impact of provider adherence to these guidelines on patient BP control has not been fully explored. Methods: We identified 3,749 new stage 1 hypertension patients (7,214 visits) and 11,013 new stage 2 hypertension patients (33,321 visits), aged ≥18, from the Vanderbilt University Medical Center database. We scrutinized outpatient BP levels, prescribed medications, follow-up visits, lab results, demographics, comorbid conditions, and physician notes from January 2018 to December 2022. This data was compared to hypertension treatment criteria developed from the 2017 guidelines that was validated by six hypertension experts. Active primary care patients (with 1 visit per year) were included. Mixed-effects Poisson regression and mixed-effects linear regression examined the relationship between guideline adherence and controlled BP (&lt;130/80 mm Hg) and continuous BP, respectively. Results: Among stage 1 hypertension visits, 12.2% were treated with at least one antihypertensive drug according to guidelines, resulting in a 13% increase in BP control and a reduction in systolic BP by 2.02 mm Hg. For stage 2 hypertension visits, 26% received treatment with at least two first-line antihypertensive drug classes, leading to a 45% increase in BP control and reductions in systolic and diastolic BP by 3.79 mm Hg and 1.93 mm Hg, respectively. No significant difference in BP control was observed among stage 2 patients treated with two versus one first-line drug. Adherence to follow-up guidelines resulted in a 24% improvement in BP control for stage 1 patients and stage 2 patients when their follow-up visit occurred within 1 month. Subsequent follow-up visits within 1-month improved BP control by 34% if BP was not controlled previously. Additionally, 42.4% of patients with uncontrolled BP for 1 month received an increase in medication dose or a change/addition of medication class and showed a 7% increase in BP control within next month. Conclusion: Provider adherence to recommended antihypertensive drug treatment guidelines (12%-26%), follow-up assessments guidelines (29%-37%), and treatment intensification (42.4%) were poor. However, patients treated according to the guidelines showed significant improved BP control.

Projected Impact of Nonpharmacologic Management of Stage 1 Hypertension Among Lower-Risk US Adults.

The 2017 American College of Cardiology/American Heart Association blood pressure guideline classified 31 million US adults as having stage 1 hypertension and recommended clinicians provide counseling on behavioral change to the low-risk portion of this group. However, nationwide reductions in cardiovascular disease (CVD) and associated health care expenditures achievable by nonpharmacologic therapy remain unquantified. We simulated interventions on a target population of US adults aged 35 to 64 years, identified from the 2015-2018 National Health and Nutrition Examination Survey, with low-risk stage 1 systolic hypertension: that is, untreated systolic blood pressure 130 to 139 mm Hg with diastolic BP <90 mm Hg; no history of CVD, diabetes, or chronic kidney disease; and a low 10-year risk of CVD. We used meta-analyses and trials to estimate the effects of population-level behavior modification on systolic blood pressure. We assessed the extent to which restricting intervention to those in regular contact with clinicians might prevent the delivery of nonpharmacologic therapy. Controlling systolic blood pressure to <130 mm Hg among the 8.8 million low-risk US adults with stage 1 hypertension could prevent 26 100 CVD events, avoid 2900 deaths, and save $1.7 billion in total direct health care costs over 10 years. Adoption of the Dietary Approaches to Stop Hypertension diet could prevent 28 000 CVD events. Other nonpharmacologic interventions could avert between 3800 and 19 500 CVD events. However, only 51% of men and 75% of women regularly interacted with clinicians for counseling opportunities. Among low-risk adults with stage 1 hypertension, substantial benefits to cardiovascular health could be achieved through public policy that promotes the adoption of nonpharmacologic therapy.

Racial and Ethnic Disparities in Antihypertensive Medication Prescribing Patterns and Effectiveness.

Variability in drug effectiveness and provider prescribing patterns have been reported in different racial and ethnic populations. We sought to evaluate antihypertensive drug effectiveness and prescribing patterns among self-identified Hispanic/Latino (Hispanic), Non-Hispanic Black (Black), and Non-Hispanic White (White)populations that enrolled in the NIH All of Us Research Program, a US longitudinal cohort. We employed a self-controlled case study method using electronic health record and survey data from 17,718 White, Hispanic, and Black participants who were diagnosed with essential hypertension and prescribed at least one of 19 commonly used antihypertensive medications. Effectiveness was determined by calculating the reduction in systolic blood pressure measurements after 28 or more days of drug exposure. Starting systolic blood pressure and effectiveness for each medication were compared for self-reported Black, Hispanic, and White participants using adjusted linear regressions. Black and Hispanic participants were started on antihypertensive medications at significantly higher SBP than White participants in 13 and 7 out of 19 medications, respectively. More Black participants were prescribed multiple antihypertensive medications (58.46%) than White (52.35%) or Hispanic (49.9%) participants. First-line HTN medications differed by race and ethnicity. Following the 2017 American College of Cardiology and the American Heart Association High Blood Pressure Guideline release, around 64% of Black participants were prescribed a recommended first-line antihypertensive drug compared with 76% of White and 82% of Hispanic participants. Effect sizes suggested that most antihypertensive drugs were less effective in Hispanic and Black, compared with White, participants, and statistical significance was reached in 6 out of 19 drugs. These results indicate that Black and Hispanic populations may benefit from earlier intervention and screening and highlight the potential benefits of personalizing first-line medications.

Predicted Cardiovascular Risk by the PREVENT Equations in US Adults With Stage 1 Hypertension.

The 2017 American College of Cardiology/American Heart Association blood pressure guideline recommends initiation of antihypertensive medication for adults with stage 1 hypertension (systolic blood pressure, 130-139 mm Hg, or diastolic blood pressure, 80-89 mm Hg) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥10% estimated by the pooled cohort equations (PCEs). In 2023, the American Heart Association published the predicting risk of cardiovascular disease events (PREVENT) equations to estimate ASCVD and total cardiovascular disease risk. We analyzed US National Health and Nutrition Examination Survey data from 2013 to 2020 for 1703 adults aged 30 to 79 years without self-reported cardiovascular disease with stage 1 hypertension. We estimated 10-year ASCVD risk by the PCEs and 10-year ASCVD and total cardiovascular disease risk by the base PREVENT equations. Analyses were weighted to represent noninstitutionalized US adults with stage 1 hypertension. Mean 10-year ASCVD risk was 5.4% (95% CI, 5.0%-5.9%) and 2.9% (95% CI, 2.7%-3.1%) using the PCEs and PREVENT equations, respectively. The proportion with 10-year ASCVD risk of 10% to <15% and ≥15% was 8.1% and 7.8% estimated by the PCEs, respectively, and 3.0% and 0.3% estimated by the PREVENT equations, respectively. No participants had a 10-year ASCVD risk ≥10% on the PREVENT equations and <10% on the PCEs, while 12.5% had a 10-year ASCVD risk ≥10% on the PCEs and <10% on the PREVENT equations. The mean 10-year total cardiovascular disease risk estimated by the PREVENT equations was lower than the mean 10-year ASCVD risk on the PCEs. Among US adults with stage 1 hypertension, the 10-year predicted ASCVD risk estimated by the PREVENT equations was approximately half the risk estimated by the PCEs.

BP classification using the 2017 ACC/AHA BP guidelines with risk of cardiovascular events in older individuals

BackgroundThe association between stage 1 hypertension and the risk of cardiovascular disease (CVD) has not been established in older adults. Furthermore, little is known about whether lowering blood pressure (BP) is beneficial in older adults with stage 1 hypertension. MethodsThis cohort study analyzed nationwide data collected from the Japanese DeSC database, including 476,654 individuals aged ≥60 years. Individuals were categorized into four groups according to the 2017 ACC/AHA BP guidelines: normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension. The primary outcome was a composite CVD event, including myocardial infarction, angina pectoris, stroke, and heart failure. ResultsDuring a mean follow-up of 3.1 years, 53,946 composite CVD events were recorded. Hazard ratios of stage 1 hypertension for composite CVD events, myocardial infarction, angina pectoris, stroke, and heart failure were 1.10 (95 % CI, 1.07–1.13), 1.16 (95 % CI, 1.03–1.31), 1.06 (95 % CI, 1.01–1.10), 1.13 (95 % CI, 1.08–1.18), and 1.13 (95 % CI, 1.09–1.16), respectively. Individuals with a ≥5 mmHg decrease in systolic BP over one year had a lower risk of stroke among individuals with stage 1 hypertension. The positive association between stage 1 hypertension and composite CVD events was attenuated in individuals aged ≥75 years. ConclusionsStage 1 hypertension is associated with a higher risk of developing CVD events among older adults. The 2017 ACC/AHA BP guidelines could be applied to older populations; however, the applicability of these guidelines to older adults aged ≥75 years requires further investigations.

Study protocol: Collaboration Oriented Approach to Controlling High blood pressure (COACH) in adults – a randomised controlled trial

IntroductionHypertension, the clinical condition of persistent high blood pressure (BP), is preventable yet remains a significant contributor to poor cardiovascular outcomes. Digital self-management support tools can increase patient self-care behaviours...

Dietary antioxidants and hypertension among menopausal women in Rafsanjan Cohort Study

Studies on the beneficial role of dietary antioxidants in preventing or managing hypertension in postmenopausal women are infrequent. The present cross-sectional study aimed to assess the association between dietary antioxidants and hypertension among menopausal women in Rafsanjan, a city located in the southeast of Iran. This study was based on data from the Rafsanjan Cohort Study (RCS), as part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN). Among 2359 postmenopausal women, finally, 1936 women were included in this study. Participants were grouped as having normal blood pressure (BP), elevated BP, stage 1 hypertension, or stage 2 hypertension as defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline. A food frequency questionnaire (FFQ), was utilized to ascertain the levels of various nutrients and dietary antioxidants in the diet. The association between dietary intakes of antioxidants and blood pressure groups was evaluated by crude and adjusted models in the multinominal logistics regression analysis. Normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension were observed in 35.69%, 3.62%, 10.59%, and 50.10% of postmenopausal women respectively. In the adjusted model, in subjects with higher consumption of β-carotene, the odds ratios of elevated BP in the 3rd quartile was about 2 times (OR: 2.04 (1.06–3.93) higher than 1st quartile. Also, in subjects with medium quality of DAQS, the odds ratios of elevated BP and stage 1 blood pressure were about 2 times (OR: 2.09 (1.05–4.17) and 1.69 times (OR: 1.69 (1.09–2.63) higher than subjects with low quality respectively. Furthermore, we did not find any statistically significant association between increased intake of dietary antioxidants and decreased odds of hypertension. After controlling the effects of confounding variables, increased dietary intake of selenium, carotenoids, vitamin A, vitamin C, and vitamin E did not decrease the odds of hypertension in postmenopausal women. Accordingly, it is suggested that this association be further investigated in the follow-up phase of this prospective study.

Current Trends in Hypertension Identification and Management: Insights from the National Health and Nutrition Examination Survey (NHANES) Following the 2017 ACC/AHA High Blood Pressure Guidelines.

Hypertension is a global health issue associated with increased cardiovascular morbidity and mortality. This study aimed to investigate contemporary hypertension identification and management trends following the 2017 American College of Cardiology/American Heart Association guidelines. Data from the National Health and Nutrition Examination Survey conducted from 2017 to 2020 were analyzed. Participants between 20 and 79 years of age were included. Participants were stratified into different treatment groups based on indication and guideline adherence. Descriptive statistics were used to compare medication use, diagnosis rates, and blood pressure control. A total of 265 402 026 people met the inclusion criteria, of which 19.0% (n=50 349 209) were undergoing guideline antihypertensive management. In the guideline antihypertensive management group, a single antihypertensive class was used to treat 45.7% of participants, and 55.2% had uncontrolled blood pressure. Participants not undergoing guideline antihypertensive management qualified for primary prevention in 11.5% (n=24 741 999) of cases and for secondary prevention in 2.4% (n=5 070 044) of cases; of these, 66.3% (n=19 774 007) did not know they may have hypertension and were not on antihypertensive medication. Adherence to guidelines for antihypertensive management is suboptimal. Over half of patients undergoing guidelinetreatment had uncontrolled blood pressure. One-third of qualifying participants may not be receiving treatment. Education and medical management were missing for 2 in 3 qualifying participants. Addressing these deficiencies is crucial for improving blood pressure control and reducing cardiovascular event outcomes.

Representation of Real-World Adults With Chronic Kidney Disease in Clinical Trials Supporting Blood Pressure Treatment Targets.

Little is known about how well trial participants with chronic kidney disease (CKD) represent real-world adults with CKD. We assessed the population representativeness of clinical trials supporting the 2021 Kidney Disease: Improving Global Outcomes blood pressure (BP) guidelines in real-world adults with CKD. Using a cross-sectional analysis, we identified patients with CKD who met the guideline definition of hypertension based on use of antihypertensive medications or sustained systolic BP ≥120 mm Hg in 2019 in the Veterans Affairs and Kaiser Permanente of Southern California. We applied the eligibility criteria from 3 BP target trials, SPRINT (Systolic Pressure Intervention Trial), ACCORD (Action to Control Cardiovascular Risk in Diabetes), and AASK (African American Study of Kidney Disease), to estimate the proportion of adults with a systolic BP above the guideline-recommended target and the proportion who met eligibility criteria for ≥1 trial. We identified 503 480 adults in the Veterans Affairs and 73 412 adults in Kaiser Permanente of Southern California with CKD and hypertension in 2019. We estimated 79.7% in the Veterans Affairs and 87.3% in the Kaiser Permanente of Southern California populations had a systolic BP ≥120 mm Hg; only 23.8% [23.7%-24.0%] in the Veterans Affairs and 20.8% [20.5%-21.1%] in Kaiser Permanente of Southern California were trial-eligible. Among trial-ineligible patients, >50% met >1 exclusion criteria. Major BP target trials were representative of fewer than 1 in 4 real-world adults with CKD and hypertension. A large proportion of adults who are at risk for cardiovascular morbidity from hypertension and susceptible to adverse treatment effects lack relevant treatment information.

Abstract 09: The Diagnostic Accuracy of Using Borderline High Office Blood Pressure Thresholds to Diagnose Masked Hypertension According to the 2017 American College of Cardiology / American Heart Association Blood Pressure Guideline

Background: Compared to adults with sustained normotension (i.e. those with neither high office blood pressure [BP] nor high out-of-office BP), adults with masked hypertension (i.e. those with high out-of-office BP but not high office BP) have an increased risk of cardiovascular disease events. The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline recommends using ambulatory BP monitoring (ABPM) to detect masked hypertension among adults with an office BP close to the high BP threshold (i.e. office systolic BP [SBP] 120 to &lt;130 mmHg or diastolic BP [DBP] 75 to &lt;80 mmHg) and not taking antihypertensive medication (Class IIa recommendation). Limited data exist on the diagnostic accuracy of using this approach to detect masked hypertension. Methods: We analyzed data from the Improving the Detection of Hypertension Study, a community-based study of adult participants, from Upper Manhattan, not taking antihypertensive medication. Office BP was measured using a validated Omron oscillometric device (Model HEM-790IT or HEM-791IT) and ABPM was performed using a validated Spacelabs device (Model 90207). Sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), false positive rate (FPR), and false negative rate (FNR) of having an office SBP 120 to &lt;130 mmHg or DBP 75 to &lt;80 mmHg for the diagnosis of high BP on ABPM were determined among 263 participants who had a mean SBP &lt;130 mmHg and mean DBP &lt;80 mmHg based on 6 SBP and 6 DBP readings from the first 2 visits (i.e. 3 SBP and 3 DBP readings per visit), and a sufficient number of ABPM readings (i.e. ≥10 awake and ≥5 asleep readings). High BP on ABPM was defined as mean awake SBP ≥130 mmHg or mean awake DBP ≥80 mmHg as per the 2017 ACC/AHA BP guideline. In a sensitivity analysis, high BP on ABPM was defined as mean 24-hour SBP ≥125 mmHg or mean 24-hour DBP ≥75 mmHg. Results: Mean (SD) age was 39.2 (12.8) years, 62.4% were female, 16.7% were non-Hispanic White, 14.4% were non-Hispanic Black, 6.8% were non-Hispanic Asian, 60.8% were Hispanic, and 1.3% were Other race/ethnicity. Of the 263 participants, 101 (38.4%) had an office SBP 120 to &lt;130 mmHg or DBP 75 to &lt;80 mmHg, and 69 (26.2%) had high BP on ABPM (awake SBP/DBP ≥130/80 mmHg). SN, SP, PPV, NPV, FPR, and FNR were 75.4%, 74.7%, 51.5%, 89.5%, 25.3%, and 24.6%, respectively. When using mean 24-hour SBP/DBP to define high BP on ABPM, SN, SP, PPV, NPV, FPR, and FNR were 72.7%, 75.8%, 55.4%, 87.0%, 24.2%, and 27.3%, respectively. Conclusions: The 2017 ACC/AHA BP guideline currently would require only 38.4% of participants with mean office BP &lt;130/80 mmHg to be screened with ABPM for masked hypertension using a screening office BP threshold of SBP 120 to &lt;130 mmHg or DBP 75 to &lt;80 mmHg. However, this approach had a substantial rate of false positives and false negatives. Investigation of alternative diagnostic screening approaches for masked hypertension is needed.

Prevalence of Self-Reported Hypertension and Antihypertensive Medication Use Among Adults - United States, 2017-2021.

Hypertension, or high blood pressure, is a major risk factor for heart disease and stroke. It increases with age and is highest among non-Hispanic Black or African American persons, men, persons aged ≥65 years, those of lower socioeconomic status, and those who live in the southern United States. Hypertension affects approximately one half of U.S. adults, and approximately one quarter of those persons have their blood pressure under control. Reducing population-level hypertension prevalence and improving control is a national priority. In 2017, updated guidelines for high blood pressure in adults recommended lowering the blood pressure threshold for diagnosis of hypertension. Analysis of data from the Behavioral Risk Factor Surveillance System found that age-standardized, self-reported diagnosed hypertension was approximately 30% during 2017-2021, with persistent differences by age, sex, race and ethnicity, level of education, and state of residence. During this period, the age-standardized prevalence of antihypertensive medication use among persons with hypertension increased by 3.1 percentage points, from 59.8% to 62.9% (p<0.001). Increases in antihypertensive medication use were observed in most sociodemographic groups and in many states. Assessing current trends in hypertension diagnosis and treatment can help guide the development of policies and implementation of interventions to reduce this important risk factor for cardiovascular disease and can aid in addressing health disparities.

Abstract WP175: Effect of Acute Blood Pressure Management on Outcomes in Patients With Nontraumatic Intracerebral Hemorrhage: Quality Assurance Study

Current guidelines for blood pressure (BP) management in patients with intracerebral hemorrhage (ICH) recommend acute lowering of systolic BP (SBP) to 140 mm Hg with a maintenance goal of 130 - 150 mm Hg. There remains a knowledge gap regarding frequency of BP monitoring, and level of SBP lowering in acute phase of ICH. Our study aimed to investigate effect of frequency of BP monitoring and acute SBP lowering in ICH patients within 48 hours of their admission. Methods: We conducted a retrospective review of study from our institutional SHOUT database (Stroke Health Outcomes Database) database. All ICH patients from 2018 through 2022 were included. Data involving BP measurements, maximum SBP and average BP within the first 48 hours of admission were collected. BP was categorized into 3 categories of &lt;140, 140-160 and &gt;160 mmHg. Frequency of BP measurements was obtained and was classified as &lt;25, 25-50 and &gt; 50 measurements of BP in the first 48 hours. Demographic data along with comorbidities were included in the analysis. Outcome was considered good if the patients were discharged home or had discharge mRS of 0-2. Outcome was considered poor if patient was discharged to a subacute rehabilitation facility or had mRS of 3-5. Results: 2998 patients were found to have ICH. 64.2 % of patients achieved lower mean BP &lt; 140 mm Hg and were found to have good outcome of home disposition. These results were statistically significant (P= 0.002). BP monitoring of &gt; 50 times was more likely to result in better outcomes in patients with ICH when compared to less monitoring (P&lt;0.001). Discussion: ICH patients who had higher number of BP readings during first 48 hours of their admission were more likely to have good outcome. Aggressive lowering of SBP was associated with higher likelihood of discharge to home or mrs 0-2.