Definition Of High Blood Pressure Research Articles

Simulations of blood pressure and identification of atrial fibrillation and arterial stiffness using an extended Kalman filter with oscillometric pulsation measurements

Background and ObjectiveThe accuracy of systolic and diastolic blood pressure levels from oscillometric devices is difficult to assess for patients with atrial fibrillation and arterial stiffness; in such cases, changes in these levels from heartbeat to heartbeat can only be known if the actual total waveform during a test can be observed. Variation in these levels affects the accuracy of the algorithms in oscillometric devices where precision is of paramount importance according to the American College of Cardiology and the American Heart Association. Recently issued guidelines lowered the definition of high blood pressure; approximately three-quarters of men over 65 years of age meet the criterion and are diagnosed as hypertensive. A review in 2019 reported that atrial fibrillation affects approximately 3% of the general population in the U.S. and is twice as common in hypertensive patients. The actual shape and details of the arterial blood pressure waveform not only reveal variations in rhythm and in systolic and diastolic levels but has also proven to be valuable in the diagnosis of arterial stiffness and atrial fibrillation which are vital to determining the physiological status of a patient's cardiovascular system. This research pertains to the identification of a patient's total arterial blood pressure waveform using only the measured pulsations in the cuff of an oscillometric device. MethodEmpirically formulated hypothetical arterial blood pressure waveforms were simulated and assumed to be unknown. Oscillometric pulsations corresponding to these simulated unknown waveforms were used as input to a new model-based extended Kalman filter algorithm for identifying the levels, shape and features of the unknown waveforms. ResultsSimulations with hypothetical waveforms with varying systolic and diastolic levels and with variations in heartbeat rhythm associated arterial fibrillation and stiff arteries, demonstrate potential arterial pressure estimate accuracies of 1.5 mmHg with standard deviations on the order of 0.1 mmHg; in addition, variations in heartbeat rhythm were observed and degrees of arterial stiffness identified and quantified. ConclusionsComputational analysis of the oscillometric cuff pulsations with the extended Kalman filter can be used to detect variations in heartbeat rhythm and blood pressure levels associated atrial fibrillation, quantify arterial stiffness, and provide noninvasive continuous blood pressure monitoring without the need for electrocardiogram or photoplethysmography sensors.

Abstract P184: 2017 ACC/AHA Blood Pressure Classification and Cardiovascular Risk by Sex and Age: a 10-year Follow-up of 17.7 Million Koreans

Introduction: The ACC/AHA has lowered the definition of high blood pressure (BP) in 2017 with emphasis on individual risk assessment. However, in clinical settings without feasible risk calculation tools, it is unclear whether such BP classification alone can accurately stratify cardiovascular disease (CVD) risk across various demographic groups. Hypothesis: We hypothesized that CVD risks according to ACC/AHA BP categories differ by sex and age subgroups. Methods: We followed 17 714 343 persons, who underwent national health screening and had no prior CVD, for 10 years using the Korean National Health Insurance database. BP was classified by ACC/AHA definitions. Stage 1 and 2 hypertensions were further subcategorized into narrower systolic and diastolic BP (SBP/DBP) intervals. Outcome was the first CVD event (myocardial infarction and/or stroke). We used multivariable Cox proportional hazards model, stratified by sex and age subgroups, to calculate hazard ratios (HR) according to BP categories. Results: Effect of high BP on CVD risk varied significantly by sex and age, with greater relative hazards in women and in younger ages (figure). Elevated BP was associated with higher CVD risk, compared with normal BP, in both sexes of age 20-69, but the association was no longer significant after age 70. Among stage 1 or 2 hypertension, CVD risks significantly diverged when the ACC/AHA category was divided into narrower SBP/DBP intervals. For instance, in men of age 50-59, HRs for SBP/DBP <120/80-89, 120-129/80-89, 130-139/<80, and 130-139/80-89 mmHg—all of which are stage 1 hypertensions—were 1.09, 1.20, 1.41, and 1.43, respectively. Similar trends were seen for both sexes, but there was a greater divergence of HRs toward higher pulse pressure in men and in older ages. Conclusion: Effect of high BP on CVD risk varies significantly by sex and age, and heterogeneous risk groups may coexist in the same ACC/AHA BP category. Therefore, an individual-level risk calculation tool is crucial for precise risk assessment in persons with high BP.

ACC/AHA 2017 definition of high blood pressure: implications for women with polycystic ovary syndrome

To assess the association of insulin resistance markers, body mass index (BMI), age, and androgen levels with systemic arterial hypertension (SAH) defined according to 2017 American College of Cardiology/American Heart Association (ACC/AHA) criteria in polycystic ovary syndrome (PCOS); and to determine the risk of metabolic abnormalities in the presence of SAH defined by both the 2017 ACC/AHA and Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) criteria in women with PCOS. Cross-sectional study. Research center. Biobanked samples obtained from 233 women with PCOS and 70 controls without hirsute, ovulatory dysfunction. Metabolic, hormonal, and biochemical assessment. Blood pressure status according to 2017 ACC/AHA and JNC7 criteria and prevalence of metabolic abnormalities. The prevalence of SAH among women with PCOS was 65% (n = 152) using 2017 ACC/AHA criteria and 26.6% (n = 62) considering JNC7 criteria. The 90 women whose SAH status was changed by 2017 ACC/AHA criteria were categorized as stage 1 SAH (systolic blood pressure 130-139mmHg and/or diastolic blood pressure 80-89mmHg), requiring nonpharmacologic therapy only (lifestyle changes). The prevalence of SAH in the control group was 41.4% (n = 29) according to 2017 ACC/AHA criteria and 12.8% (n = 9) according to JNC7 criteria. In all groups, SAH was associated with higher homeostasis model assessment and insulin levels compared with normal blood pressure (P<.01). In women with PCOS, the risk ratio for glucose ≥100mg/dL (prevalence ratio 3.88, 95% confidence interval [CI] 1.30-11.55), high-density lipoprotein (HDL) <50mg/dL (prevalence ratio 2.13, 95% CI 1.45-3.12), and triglycerides ≥150mg/dL (prevalence ratio 3.39, 95% CI 1.56-7.35) was higher with SAH versus normal blood pressure when 2017 ACC/AHA criteria were applied, and did not increase or increased slightly when JNC7 criteria were applied (glucose ≥100mg/dL, prevalence ratio 1.38, 95% CI 0.99-1.91), HDL <50mg/dL (prevalence ratio 1.1, 95% CI 0.99-1.37), and triglycerides ≥150mg/dL (prevalence ratio 1.48, 95% CI 1.13-1.94). The risk of cardiometabolic co-morbidities was increased in women with SAH defined by 2017 ACC/AHA criteria. Lower cutoffs for abnormal blood pressure seem appropriate for women with PCOS, providing a simple screening tool for cardiometabolic co-morbidities and an opportunity for early primary prevention.

Update on the Hong Kong Reference Framework for Hypertension Care for Adults in Primary Care Settings—review of evidence on the definition of high blood pressure and goal of therapy

The Hong Kong Reference Framework for Hypertension Care for Adults in Primary Care Settings is updated regularly to ensure it reflects the latest medical development and best practice. In 2017, guidelines from the United States included a major change, adopting the lower blood pressure values of 130/80 mm Hg in defining hypertension, in contrast to the prevailing international consensus of 140/90 mm Hg. After thorough review of the literature and international guidelines, the Advisory Group on Hong Kong Reference Framework for Care of Diabetes and Hypertension in Primary Care Settings (Advisory Group) recommends that the definition of hypertension adopted in the Reference Framework should remain unchanged as a blood pressure of ≥140/90 mm Hg, as there is currently inadequate evidence and lack of general consensus to support such change in Hong Kong. The Advisory Group agrees on individualised treatment goals, and recommends that the initial blood pressure goal for individuals with uncomplicated hypertension should be <140/90 mm Hg; for those who can tolerate it, the goal should be ≤130/80 mm Hg. A lower blood pressure is advisable for young or overweight/obese patients, smokers, and patients with other cardiovascular risk factors.

Media Coverage of the Benefits and Harms of the 2017 Expanded Definition of High Blood Pressure

This study examines the media coverage of the expanded definition of hypertension associated with the new guidelines from the American College of Cardiology and the American Heart Association.

Implications of 2017 hypertension guidelines for Indian patients

The new US blood pressure guideline lowers the definition of high blood pressure to 130/80 mm Hg.The new guideline adopts a key component of the 2013 cholesterol guideline and incorporates overall cardiovascular risk. The AAFP has decided to not endorse the recent hypertension guideline because it gave undue importance to the SPRINT trial and cardiovascular risk which was not validated and would lead to overtreatment. The guidelines are discussed in this article.

Blood pressure measurement in children: which method? which is the gold standard

The burden of hypertension has become increasingly prevalent in children. Hypertension that begins in childhood can carry on into adulthood, therefore early detection, accurate diagnosis and effective therapy of high blood pressure may improve long-term outcomes of children and adolescents. As far as pediatric hypertension is concerned, doubts still persist about the right instruments, modalities and standards of reference that should be used in routine practice. Due to the dynamic process of growth and development, many physiological parameters undergo intensive change with age. Therefore, in children, the definition of hypertension can not rely on a single blood pressure level but should be based on age- and height-specific percentiles. In this review, we introduce the nephrologist to the correct definition of high blood pressure in children. Moreover, we specifically address the main characteristics of different modalities for blood pressure measurement in children, focusing on practical aspects. The latest international guidelines and appropriate standards of reference for office, ambulatory and home blood pressure data collection are presented. As clinicians are being faced with a greater number of children with hypertension, they should be aware of these peculiarities.

Different diagnostic criteria significantly affect the rates of hypertension in 18-year-old high school students

IntroductionChildhood hypertension is defined based on the normative distribution of blood pressure (BP), but from the age of 18 years high BP is diagnosed using adult criteria. We compared the rates of diagnosis of hypertension in a group of 18-year-old subjects using BP percentiles and the adult criteria.Material and methodsBlood pressure was measured by registered nurses in 1472 18-year-old high-school students (780 men and 692 women). Also weight, height and waist circumference were recorded.ResultsThe prevalence of hypertension was 9% (16.2% in men and 0.9% in women, p < 0.001) using adult cut-off values and 14.7% (21.9% in men and 6.6% in women, p < 0.001) using percentile charts. Obesity was diagnosed in 2.4% and overweight in 13% of subjects, respectively. The relative risk ratio of diagnosing hypertension according to the adult criteria in overweight or obese subjects was 2.94 (95% CI 2.25-3.86) in men and 6.44 (95% CI 3.51-11.82) in women.ConclusionsOur study indicates high prevalence of hypertension in 18-year-old students – especially in men – and the importance of obesity as a risk factor of hypertension. The use of percentile charts instead of adult cut-off values increases the prevalence of hypertension in men by 35% from 16.2% to 21.9% and in women more than 7 times, i.e. from 0.9% to 6.6%. It seems reasonable to use higher (i.e. 98th) percentile values for definition of high blood pressure.

Blood pressure in adult rural INDEPTH population in Asia

Introduction: High blood pressure (BP) is a well-known major risk factor for cardiovascular diseases and is a leading contributor to cardiovascular mortality and morbidity worldwide. Reliable population-based BP data from low–middle income countries are sparse.Objective: This paper reports BP distributions among adults in nine rural populations in five Asian countries and examines the association between high BP and associated risk factors, including gender, age, education, and body mass index.Methods: A multi-site cross-sectional study of the major non-communicable disease risk factors (tobacco and alcohol use, fruit and vegetable intake, physical activity patterns) was conducted in 2005 in nine Health and Demographic Surveillance System (HDSS) sites in five Asian countries, all part of the INDEPTH Network. In addition to the self-report questions on risk factors, height and weight, and BP were measured during household visits using standard protocols of the WHO STEPwise approach to Surveillance.Results: In all the study sites (except among men and women in WATCH and among women in Chililab), the mean levels of systolic BP were greater than the optimal threshold (115 mmHg). A considerable proportion of the study populations – especially those in the HDSS in India, Indonesia, and Thailand – had high BP (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or on treatment with BP medications). A more conservative definition of high BP (systolic BP ≥ 160 mmHg or diastolic BP ≥ 100 mmHg) substantially reduced the prevalence rate. The marked differences in the proportion of the populations on high BP medication (range between 0.6 and 10.8%) raised problems in comparing the prevalence of high BP across sites when using the commonly used definition of high BP as in this study. In the four HDSS in Bangladesh, women had a higher prevalence of high BP than men; the reverse was true in the other sites (Chililab, Filabavi in Vietnam; Kanchanaburi, Thailand; and Vadu, India) where men experienced higher prevalence than women. Overweight and obesity were significantly associated with high BP, with odds ratio ranging from two in Chililab to five in Filabavi (both in Vietnam HDSS).Conclusion: The patterns of BP in these nine cross-sectional surveys were complex, reflecting the fact that the Asian countries are at different stages of the epidemiological transition. Actions to prevent the rise of BP levels are urgently required. An emphasis should be placed on cost-effective interventions to reduce salt consumption in the population as an immediate priority.

Risk of hypertension amongst Swedish male snuff users: a prospective study

The scientific evidence on whether long-term use of snuff is associated with high blood pressure is limited, inconsistent and based only on cross-sectional data. We aimed at studying the risk of hypertension in relation to long-term use of snuff based on longitudinal data. Repeated health check-ups were offered to all employees in the Swedish construction industry between 1978 and 1993. Blood pressure was measured at the health check-up and information on tobacco use and other risk factors was collected through questionnaires. In total, 120 930 never smoking men with information on blood pressure and snuff use at baseline were included. The association of high blood pressure and snuff use at baseline was estimated by logistic regression. Further, 42 055 men were identified as normotensive at baseline and had at least one subsequent health check-up. Through repeated blood pressure measurements and linkage to the Swedish National Inpatient Register, information on hypertension was obtained. Relative risk estimates were derived from Cox proportional hazards regression model. Almost 30% of all men had used snuff. The adjusted odds ratio of high blood pressure amongst snuff users at baseline was 1.23 (95% CI 1.15-1.33) compared to never snuff users. The relative risk of high blood pressure during follow-up was 1.39 (95% CI 1.08-1.79) amongst snuff users and 1.36 (95% CI 1.07-1.72) for hypertension as recorded in the Inpatient Register. Use of Swedish moist snuff appears to be associated with a moderately increased risk of hypertension.

Prevalence of Hypertension in Type 2 Diabetes Mellitus: Impact of the Tightening Definition of High Blood Pressure and Association With Confounding Risk Factors

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) has recommended a downward shift in target blood pressure to <130/80 mm Hg in diabetic patients, thus operatively setting a new threshold level for the definition of hypertension at 130/80 mm Hg. The authors performed a retrospective chart analysis of 2227 type 2 diabetes patients treated in one hospital-based and two community-based clinics in central Israel to determine the prevalence of hypertension as a function of three diagnostic threshold levels. The prevalence of hypertension in this cohort was 60.2%, 76.5%, and 85.8% at blood pressure thresholds of 140/90, 130/85, and 130/80 mm Hg respectively. Hypertension prevalence increased with age, reaching a rate of 94.4% in patients aged 80 years or more when the cutoff value of 130/80 mm Hg was used. At this cutoff, 93.3% and 86.6% of patients with a body mass index over or under 30 kg/m(2), respectively, were diagnosed with hypertension. As hypertension appears to eventually afflict the vast majority of diabetic patients, the minority of subjects not developing hypertension emerges as a unique group, which potentially deserves further in-depth study.

Epidemiology of Uncontrolled Hypertension in the United States

Hypertension is a powerful risk factor for fatal and nonfatal cardiovascular disease events. Data from observational studies indicate that this risk is continuous, without evidence of a threshold, down to blood pressures as low as 115/75 mm Hg.1 Randomized controlled trials have convincingly shown that treatment of hypertension reduces the risk of stroke, coronary heart disease, congestive heart failure, and mortality.2,3 Because hypertension currently affects 1 in 4 American adults (≈65 million people in 1999 to 2000)4 and may affect >90% of individuals during their lifetimes,5 adequate control of blood pressure is of enormous public health importance. However, recent studies indicate that as many as two thirds of those with hypertension in the United States are either untreated or undertreated.6 Studies based on national data and community cohorts have shed light on the reasons underlying this poor control, but several questions remain unanswered. In this article, we review contemporary data on the epidemiology of uncontrolled hypertension in the United States by (1) defining what constitutes “controlled hypertension”; (2) describing the current magnitude of the problem, including temporal trends; (3) summarizing the public health consequences of uncontrolled hypertension; (4) examining the clinical correlates of uncontrolled hypertension and appraising the patient- and physician-related factors related to poor control of blood pressure; and (5) identifying future research directions, including potential interventions to address this problem. In this article, “uncontrolled hypertension” signifies blood pressure that is inadequately treated rather than blood pressure that is resistant to treatment, as might be observed with secondary causes of hypertension such as renal artery stenosis. The definition of high blood pressure has changed over time and differs between guidelines proposed by expert bodies. Variation in the definition of hypertension influences the number of people classified as having uncontrolled hypertension7 and may contribute …

What is normal blood pressure?

Purpose of review Given the continuous relations of blood pressure to cardiovascular risk, any definition of high blood pressure is arbitrary, and based on thresholds at which there is clear evidence that treatment benefits outweigh potential risks. This review examines what constitutes optimal blood pressure. Recent findings A recent report raised the possibility of an age- and sex-dependent threshold for risk associated with systolic blood pressure, questioning the use of a single threshold (such as 140/90 mmHg) for defining hypertension. Several subsequent studies have questioned this notion and reemphasized that lower blood pressure levels are associated with less morbidity and mortality even within the nonhypertensive range. A recent meta-analysis confirmed that a blood pressure of 115/75 mmHg is associated with minimal vascular mortality and likely constitutes optimal blood pressure. Such blood pressure levels are infrequent in westernized societies. The target blood pressure goal for treated hypertensives is higher at 140/90 mmHg but is infrequently achieved. Select individuals at high absolute risk of cardiovascular disease events and/or with specific conditions (notably diabetes, renal insufficiency and prior vascular disease) may benefit from blood pressure lowering below this threshold. Summary At a population level, a blood pressure of 115/75 mmHg seems optimal because it is associated with minimal vascular risk. Over half of all hypertensives do not have their blood pressure controlled underscoring the challenges facing health care providers. Efforts should be strengthened for the primary prevention of hypertension and the promotion of optimal blood pressure through lifestyle measures.

What is normal blood pressure?

Given the continuous relations of blood pressure to cardiovascular risk, any definition of high blood pressure is arbitrary, and based on thresholds at which there is clear evidence that treatment benefits outweigh potential risks. This review examines what constitutes optimal blood pressure. A recent report raised the possibility of an age- and sex-dependent threshold for risk associated with systolic blood pressure, questioning the use of a single threshold (such as 140/90 mmHg) for defining hypertension. Several subsequent studies have questioned this notion and reemphasized that lower blood pressure levels are associated with less morbidity and mortality even within the nonhypertensive range. A recent meta-analysis confirmed that a blood pressure of 115/75 mmHg is associated with minimal vascular mortality and likely constitutes optimal blood pressure. Such blood pressure levels are infrequent in westernized societies. The target blood pressure goal for treated hypertensives is higher at 140/90 mmHg but is infrequently achieved. Select individuals at high absolute risk of cardiovascular disease events and/or with specific conditions (notably diabetes, renal insufficiency and prior vascular disease) may benefit from blood pressure lowering below this threshold. At a population level, a blood pressure of 115/75 mmHg seems optimal because it is associated with minimal vascular risk. Over half of all hypertensives do not have their blood pressure controlled underscoring the challenges facing health care providers. Efforts should be strengthened for the primary prevention of hypertension and the promotion of optimal blood pressure through lifestyle measures.

EVALUATION AND TREATMENT OF HYPERTENSION

Hypertension is a significant and prevalent risk factor for the development of cardiovascular disease and target organ damage. The urgency of treatment of high blood pressure depends on the level of blood pressure elevation and the presence of coexistent risk factors for cardiovascular disease. Likewise, the level to which blood pressure is reduced is not restricted to the definition of high blood pressure but instead depends on the underlying disease. Diabetes and renal insufficiency, for example, require blood pressure goals below those that are traditionally defined. In the absence of contraindications, beta-blockers and diuretics are still recommended as first-line agents for treatment of uncomplicated hypertension. Calcium channel antagonists also may reduce mortality. In patients with diabetes, ACE inhibitors are effective first-line agents in type 1 and type 2 diabetic patients who are hypertensive or have microalbuminuria. ACE inhibitors may be beneficial in patients with nondiabetic renal insufficiency as well. Calcium channel antagonists may have some effect in retarding progression of diabetic nephropathy although a recent trial found a higher incidence of death as a secondary endpoint in hypertensive diabetic patients who were treated with calcium channel antagonists. Beta-blockers seem to be safe and well tolerated in patients with mild to moderate intermittent claudication, although patients with rest pain or limb ischemia have not been studied. Beta-blockers should not be used in patients with asthma. Dihydropyridine calcium channel antagonists are the preferred treatment of hypertension in patients with Raynaud's but should be avoided in patients with severe gastroesophageal reflux disease. NSAIDs, particularly piroxicam and indomethacin, raise mean blood pressure by approximately 5 mm Hg, enough to consider a change of either NSAID or antihypertensive to one that is not as affected by NSAIDs. Cyclosporine A can induce hypertension by its vasoconstrictive effects, particularly on the kidney. Calcium channel antagonists may antagonize this vasoconstriction while allowing the clinician to reduce the dose of cyclosporine A required to achieve its immunosuppressive effect.

Lessons learned and future directions

The definition of high blood pressure needs to be made more clinically relevant and predictive of future cardiovascular sequelae. Age, sex, genetic factors, diet, environment, behavior, and mental attitude can influence hemodynamics and cardiovascular outcomes. The greater the number of blood pressure determinations, the more valid the diagnosis of hypertension. Mean daily blood pressure determined by ambulatory monitoring is generally conceded to be the most significant prognosticator but is not suitable for routine use. Psychophysiologic stress testing may provide a means of estimating the mean daily blood pressure. Carbon dioxide rebreathing and other techniques being investigated may also provide useful hemodynamic measurements. Because of the adverse impacts of antihypertensive medications, nonpharmacologic approaches to treatment may be preferable where possible. Biofeedback and relaxation techniques have benefited certain persons. A comprehensive program that includes additional approaches has provided significant improvements and is briefly described. An overview of the conference presentations is also included.

SCREENING FOR HYPERTENSION IN UNIVERSITY OF FLORIDA STUDENTS

College Students aged 18-30 years were screened for hypertension at the student infirmary. 550 students had a single blood pressure reading taken in the sitting position. 50 students (9%) fulfilled our definition of high blood pressure by having either a systolic pressure equal to or greater than 140 mm/Hg or a diastolic pressure equal to or greater than 90 mm/Hg. Of these students with abnormal blood pressures, 34 returned for 2 further determinations. 22/34 (65%) demonstrated persistent hypertension during each of the three visits. Of those with persistent hypertension, 6/22 (27%) had an elevation of the systolic pressure, 4/22 (18%) had an elevation of the diastolic pressure and 12/22 (54%) had an elevation of both when initially screened. Of the 12 students without persistence of hypertension (labile), 3/12 (25%) had an elevated systolic pressure, 4/22 (33%) had an elevated diastolic pressure, and 5/22 (43%) had an elevation of both.Only 3/22 (14%) of the students with persistent and none with labile hypertension had a diastolic pressure equal to or greater than 105 mm/Hg on the initial screening pressure, indicating hypertension is usually mild in this age group. The type of hypertension (systolic, diastolic, or both) does not allow the identification of those individuals who have labile or persistent hypertension.