Heart Association Hypertension Guidelines Research Articles

Chronic Hypertension During Pregnancy: Prevalence and Treatment in the United States, 2008-2021.

Treatment of chronic hypertension during pregnancy has been shown to reduce the risk of adverse perinatal outcomes. In this study, we examined the prevalence and treatment of chronic hypertension during pregnancy and assessed changes in these outcomes following the release of the updated 2017 hypertension guidelines of the American College of Cardiology and American Heart Association. We analyzed the MerativeTM Marketscan® Research Database of United States commercial insurance claims from 2007 to 2021. We assessed the prevalence of chronic hypertension during pregnancy and oral antihypertensive medication use over time. We then performed interrupted time series analyses to evaluate changes in these outcomes. The prevalence of chronic hypertension steadily increased from 1.8% to 3.7% among 1 900 196 pregnancies between 2008 and 2021. Antihypertensive medication use among pregnant individuals with chronic hypertension was relatively stable (57%-60%) over the study period. The proportion of pregnant individuals with chronic hypertension treated with methyldopa or hydrochlorothiazide decreased (from 29% to 2% and from 11% to 5%, respectively), while the proportion treated with labetalol or nifedipine increased (from 19% to 42% and from 9% to 17%, respectively). The prevalence or treatment of chronic hypertension during pregnancy did not change following the 2017 American College of Cardiology and American Heart Association hypertension guidelines. The prevalence of chronic hypertension during pregnancy doubled between 2008 and 2021 in a nationwide cohort of individuals with commercial insurance. Labetalol replaced methyldopa as the most commonly used antihypertensive during pregnancy. However, only about 60% of individuals with chronic hypertension in pregnancy were treated with antihypertensive medications.

IS IT REASONABLE TO DECREASE THE DEFINITION OF DIASTOLIC HYPERTENSION FROM 90 MMHG TO 80 MMHG IN THE ELDERLY? THE NORTHERN SHANGHAI STUDY

Objective: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines decreased the definition of diastolic hypertension to 80 mmHg from 90 mmHg. However, this action may not be appropriate in the elderly, considering the limited value of increased DBP in predicting future cardiovascular risk and the worse prognosis associated with significant lower DBP in the elderly. Design and method: A total of 1178 participants with SBP<130 mmHg derived from the Northern Shanghai Study, a prospective study focusing on the cardiovascular risk of the community-dwelling elderly Chinese in the northern Shanghai, China, were included. Study participants were divided into Group 1 (DBP<80 mmHg) and Group 2 (80<DBP<90 mmHg) according to DBP level. Survival analysis and Cox proportional hazard regression were used to study the future cardiovascular risk of the two groups. Results: After 5.8 years of follow-up, a total of 172 events were observed. Survival analysis showed no significant difference in the rates of the primary endpoints between two groups (14.9%vs14.0%, P = 0.80). In multiple COX proportional hazard regression, after adjusted for covariates, participants in Group 2 showed similar future cardiovascular risk (Hazard Ratio 1.05, 95% Confidence Interval 0.75-1.48, P = 0.78), as compared with Group 1. Conclusions: No increased cardiovascular risk observed in the elderly with SBP<130 mmHg and DBP between 80-90 mmHg, compared with those with DBP<80 mmHg. Therefore, it is maybe unreasonable to downregulate the definition of the diastolic hypertension in the elderly.

The 2017 American College of Cardiology/American Heart Association Hypertension Guideline and Blood Pressure in Older Adults

The 2017 American College of Cardiology/American Heart Association blood pressure guideline redefined hypertension and lowered the blood pressure treatment target. Empirical data on the guideline's impact are needed. Data were analyzed from Atherosclerosis Risk in Communities study participants who attended baseline pre-guideline (2016-2017) and post-guideline (2018-2019) visits with baseline systolic blood pressure between 120 and 159 mmHg. Participants were grouped according to baseline systolic blood pressure by change in classification under the new guideline as follows: not reclassified (120-129 mmHg), reclassified to Stage 1 hypertension (130-139 mmHg), and reclassified to Stage 2 hypertension (140-159 mmHg). Means and 95% CIs for systolic blood pressure changes between baseline and follow-up, changes in antihypertensive use, and percentages that achieved the post-guideline recommendation (systolic blood pressure <130 mmHg) were calculated. Analyses were performed in 2021-2022. Among 2,193 community-dwelling Atherosclerosis Risk in Communities participants aged 71-95 years at baseline, systolic blood pressure changes between baseline and follow-up visits differed among participants not reclassified (+4.1 mmHg, 95% CI=3.0, 5.3 mmHg), reclassified to Stage 1 hypertension (-1.1 mmHg, 95% CI= -2.2, 0.1 mmHg), and reclassified to Stage 2 hypertension (-5.7 mmHg, 95% CI= -6.8, -4.7 mmHg). Antihypertensive use changed from 77.3% to 78.4% (p=0.25) among participants reclassified to Stage 1 hypertension and from 78.3% to 81.4% (p<0.01) among participants reclassified to Stage 2 hypertension. At follow-up, 41.8% of the Stage 1 and 22.4% of the Stage 2 hypertension groups reached the systolic blood pressure <130 mmHg goal. There were small decreases in systolic blood pressure and increases in antihypertensive therapy among older adults reclassified to Stage 2 hypertension but not among those reclassified to Stage 1 hypertension by the 2017 American College of Cardiology/American Heart Association guideline.

PS-C10-2: POTENTIAL IMPACT OF THE 2017 AMERICA COLLEGE OF CARDIOLOGY/AMERICAN HEART ASSOCIATION HIGH BLOOD PRESSURE GUIDELINES ON SECONDARY PREVENTION POPULATION

Objective: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guidelines for adults have redefined blood pressure (BP) thresholds for diagnosis and treatment initiation as well as BP goals. We wanted to explore the potential impact of these recommendations on the prevalence of uncontrolled hypertension and target achievement in a secondary prevention population receiving anti-hypertensive treatment in line with the previous Guidelines. Design &amp; Methods: This was a retrospective study in ambulatory patients attending a secondary cardiovascular disease prevention programme(mean age 62 ± 14, 77% male)using prospectively collected data from electronic medical records (Apollo Lx). Data analysed using JMP, version 7.1(SAS for Windows). Hypertension and target achieved were classified on the basis of previous International (BP &lt; 140/90 mm Hg) as well as the new ACC/AHA Guidelines (BP &lt; 130/80 mm Hg). Results were analysed using JMP Version 7.1(SAS for Windows). Results: Applying the new ACC/AHA cut-offs for BP, the proportion of patients with high normal BP decreased from 63% to 28% (p &lt; 0.001), which translated into an increase in the prevalence of Stage I (39% vs. 15%, p &lt; 0.0001) and Stage II hypertension (14.7% vs. 0.9%, p &lt; 0.001). Overall, BP target was achieved in 75% of the patients using the old definition, compared with 43% with the new ACC/AHA Guidelines. Using the old definition, men were more likely to achieve target BP (78% vs. 72%, P &lt; 0.0001) than women; however with the new cut-offs, BP target achieved was similar in men(42.8%) and women(43%). Using the old definition, some 84% of diabetics achieved BP control, decreasing to 52%with the new Guidelines. 71% of patients with renal impairment had BP targets achieved using the previous definition, compared with 41% in line with the new Guidelines. Conclusions: Compared with the previous European, British and American Guidelines, the new 2017 ACC/AHA recommendations resulted in a substantial increase in the prevalence of uncontrolled hypertension and reduction in patients achieving BP targets in our population. If taken up, these recommendations carry significant implications of increase in the number of anti-hypertensive drug prescribing, issues like polypharmacy, non-adherence and adverse drugs effects, with resultant escalation in health care costs.

Prevalence, awareness, treatment, and control rates of hypertension in patients hospitalized with atrial fibrillation in China: Findings from the CCC-AF project.

BackgroundThe status of hypertension in patients with atrial fibrillation (AF) remains unknown in China.MethodsThis study used data from patients hospitalized with AF recruited by the Improving Care for Cardiovascular Disease in China-AF (CCC-AF) project from 236 hospitals enrolled by geographic-economic level in China from 2015 to 2019. The prevalence, awareness, treatment, and control rates of hypertension in patients hospitalized with AF were estimated. Multivariable logistic regression was used to analyze the factors associated with uncontrolled hypertension.ResultsAmong 60,390 patients hospitalized with AF, the prevalence of hypertension according to the 2018 Chinese hypertension guidelines was 66.1%. The awareness, treatment, and control rates of hypertension were 80.3, 55.8, and 39.9%, respectively. Among patients treated for hypertension, the treatment control rate was 46.2%. These rates varied according to patient clinical characteristics and geographic regions. The young (18–44 and 45–54 years old), rural insurance, alcohol drinking, history of heart failure, valvular AF, first diagnosed AF, and permanent AF, were associated with uncontrolled hypertension. Under the 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines, the prevalence of hypertension was 79.3%, and the control and treatment control rates dropped to 16.7 and 21.2%, respectively.ConclusionHypertension is common in patients hospitalized with AF in China. Although most patients were aware of their hypertensive status, the treatment and control rates of hypertension were still low. The management of hypertension in patients with AF needs to be further improved.

Hypertension Subtypes, Mortality Risk, and Differential Effects Between Two Hypertension Guidelines.

Aim:To examine which hypertension subtypes are primarily responsible for the difference in the hypertension prevalence and treatment recommendations, and to assess their mortality risk if 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guideline were adopted among Chinese adults.MethodsWe used the nationally representative data of China Health and Retirement Longitudinal Study (CHARLS) to estimate the differences in the prevalence of isolated systolic hypertension (ISH), systolic diastolic hypertension (SDH) and isolated diastolic hypertension (IDH) between the 2017 ACC/AHA and the 2018 China Hypertension League (CHL) guidelines. We further assessed their mortality risk using follow-up data from the China Health and Nutrition Survey (CHNS) by the Cox model.ResultsThe increase from the 2017 ACC/AHA guideline on hypertension prevalence was mostly from SDH (8.64% by CHL to 25.59% by ACC/AHA), followed by IDH (2.42 to 6.93%). However, the difference was minuscule in the proportion of people recommended for antihypertensive treatment among people with IDH (2.42 to 3.34%) or ISH (12.00 to 12.73%). Among 22,184 participants with a median follow-up of 6.14 years from CHNS, attenuated but significant associations were observed between all-cause mortality and SDH (hazard ratio 1.56; 95% CI: 1.36,1.79) and ISH (1.29; 1.03,1.61) by ACC/AHA but null association for IDH (1.15; 0.98,1.35).ConclusionAdoption of the 2017 ACC/AHA may be applicable to improve the unacceptable hypertension control rate among Chinese adults but with cautions for the drug therapy among millions of subjects with IDH.

Potential Impact of 2017 American College of Cardiology/American Heart Association Hypertension Guideline on Contemporary Practice: A Cross-Sectional Analysis From NCDR PINNACLE Registry.

BackgroundClinical implications of change in the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the diagnosis and management of hypertension, compared with recommendations by 2014 expert panel and Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), are not known.Methods and ResultsUsing data from the NCDR (National Cardiovascular Data Registry) PINNACLE (Practice Innovation and Clinical Excellence) Registry (January 2013‐Decemver 2016), we compared the proportion and clinical characteristics of patients seen in cardiology practices diagnosed with hypertension, recommended antihypertensive treatment, and achieving blood pressure (BP) goals per each guideline document. In addition, we evaluated the proportion of patients at the level of practices meeting BP targets defined by each guideline. Of 6 042 630 patients evaluated, 5 027 961 (83.2%) were diagnosed with hypertension per the 2017 ACC/AHA guideline, compared with 4 521 272 (74.8%) per the 2014 panel and 4 545 976 (75.2%) per JNC7. The largest increase in hypertension prevalence was seen in younger ages, women, and those with lower cardiovascular risk. Antihypertensive medication was recommended to 70.6% of patients per the ACC/AHA guideline compared with 61.8% and 65.9% per the 2014 panel and JNC7, respectively. Among those on antihypertensive agents, 41.2% achieved BP targets per the ACC/AHA guideline, compared with 79.4% per the 2014 panel and 64.3% per JNC7. Lower proportions of women, non‐White (Black and "other") races, and those at higher cardiovascular risk achieved BP goals. Median practice‐level proportion of patients meeting BP targets per the 2014 panel but not the ACC/AHA guideline was 37.8% (interquartile range, 34.8%–40.7%) and per JNC7 but not the ACC/AHA guideline was 22.9% (interquartile range, 19.8%–25.9%).ConclusionsFollowing publication of the 2017 guideline, significantly more people, particularly younger people and those with lower cardiovascular risk, will be diagnosed with hypertension and need antihypertensive treatment compared with previous recommendations. Significant practice‐level variation in BP control also exists. Efforts are needed to improve guideline‐concordant hypertension management in an effort to improve outcomes.

Hypertension in Healthy College Students: The Hypertension in Young Adults (HiYA) Study

ABSTRACT Introduction/Purpose The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guidelines lowered the threshold for hypertension, and more individuals are likely to be diagnosed with elevated blood pressure (BP; 120–129/&lt;80 mm Hg) or hypertension (stage 1, 130–139/80–89 mm Hg; stage 2, ≥140/90 mm Hg). Prevalence of hypertension in the lower end of the young adult/college-aged group aged 18–24 yr is not well characterized and how the revised guidelines apply to this age group has not yet been studied. Therefore, the primary purpose of this study was to determine the potential prevalence of hypertension in a population of healthy college students using the 2017 ACC/AHA Hypertension Guidelines. Methods Resting BP was measured in 87 individuals (20.7 ± 1.7 yr, 49 females (F), 38 males (M)) using the auscultatory method according to American Heart Association guidelines. The average of two readings was used. Results Forty-seven (32 F, 15 M) participants had normal (&lt;120/&lt;80 mm Hg) BP. Twenty participants (10 F, 10 M) had elevated BP (systolic BP (SBP), 122.4 ± 2.9; diastolic BP (DBP), 72.8 ± 6.2 mm Hg), and 20 were classified as in either stage 1 (n = 14: 5 F, 9 M; SBP, 125.3 ± 7.1; DBP, 82.7 ± 6.8 mm Hg) or stage 2 (n = 6: 2 F, 4 M; SBP, 141.3 ± 9.8; DBP, 86.2 ± 13.4 mm Hg) hypertension categories. Conclusions Under the 2017 guidelines, 46% of the study population was classified in the elevated BP or hypertensive categories, revealing a much-higher-than-expected potential prevalence in this apparently healthy, physically active population of college students. More educational efforts are needed to promote hypertension awareness among college students.

Ten-Second Heart Rate Variability, Its Changes Over Time, and the Development of Hypertension.

The role of ultrashort-term heart rate variability (HRV) and its temporal changes in incident hypertension are unknown. We aimed to investigate the association between 10-second HRV, its changes, and incident hypertension in adults aged <40 years and older. This cohort study included 232 587 Koreans (mean age 37.6 years) without hypertension. Hypertension was defined according to the 2017 American College of Cardiology and American Heart Association hypertension guidelines. HRV, including the root mean square of successive R-R interval differences and the SD of normal-to-normal R-R intervals, was estimated using standard 12-lead, 10-second electrocardiography. During a median follow-up of 3.8 years, 40 268 hypertension cases were identified (incidence rates: 36.1 and 67.9 per 1000 person-years for young and older participants, respectively). An inverse association was observed between HRV and hypertension risk, in a dose-dependent manner. The multivariable-adjusted hazard ratios (95% CIs) for hypertension comparing the first to the fifth quintiles of root mean square of successive R-R interval difference and SD of normal-to-normal R-R interval were 1.58 (1.52-1.63) and 1.35 (1.30-1.39), respectively. These associations were stronger in young adults than in older adults. In a subsample of 150 301 participants, compared with stable HRV, an increase in HRV over time was also inversely associated with incident hypertension. A higher HRV and its increase over time on a 10-second electrocardiography were associated with a lower risk of hypertension. Our findings indicate that autonomic function, estimated using 10-second standard electrocardiography, plays a role in predicting hypertension, with a stronger effect in young adults.

Adoption of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guideline in Hong Kong and implications for local practice.

Adoption of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guideline in Hong Kong and implications for local practice.

Isolated diastolic hypertension is not associated with endothelial dysfunction.

Hypertension is associated with an impairment of endothelial function. However, it is unclear whether isolated diastolic hypertension is associated with endothelial dysfunction. The purpose of this study was to investigate the association of endothelial function with isolated diastolic hypertension diagnosed by using two major hypertension guidelines: systolic blood pressure (BP) < 130 mmHg and diastolic BP ≥ 80 mmHg according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline and systolic BP < 140 mmHg and diastolic BP ≥ 90 mmHg according to the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) hypertension guideline. We measured the flow-mediated vasodilation (FMD) of the brachial artery in subjects without systolic hypertension who were not treated with antihypertensive drugs. Of 3727 subjects (2813 men; mean age: 41.3 ± 10.9 years), 749 (20.1%) had isolated diastolic hypertension according to the 2017 ACC/AHA definition. Multiple logistic regression analysis revealed that isolated diastolic hypertension was not associated with endothelial dysfunction, defined as FMD < 7.0% (OR, 1.15; 95% CI, 0.98-1.35; P = 0.09). Of 4747 subjects (3727 men; mean age: 45.1 ± 10.8 years), 314 subjects (6.6%) had isolated diastolic hypertension according to the ESC/ESH definition. Multiple logistic regression analysis revealed that isolated diastolic hypertension was not associated with endothelial dysfunction after adjusting for age and sex (OR, 1.04; 95% CI, 0.82-1.32; P = 0.76). Isolated diastolic hypertension was not associated with endothelial dysfunction in individuals who were not treated with antihypertensive drugs regardless of the major hypertension guideline definition used.

Should Estimated Glomerular Filtration Rate Be Adjusted for Race?

Should Estimated Glomerular Filtration Rate Be Adjusted for Race?

Cost-Effectiveness of Recommendations From the Surgeon General's Call-to-Action to Control Hypertension.

In response to high prevalence of hypertension and suboptimal rates of blood pressure (BP) control in the United States, the Surgeon General released a Call-to-Action to Control Hypertension (Call-to-Action) in the fall of 2020 to address the negative consequences of uncontrolled BP. In addition to morbidity and mortality associated with hypertension, hypertension has an annual cost to the US healthcare system of $71 billion. The Call-to-Action makes recommendations for improving BP control, and the purpose of this review was to summarize the literature on the cost-effectiveness of these strategies. We identified a number of studies that demonstrate the cost saving or cost-effectiveness of recommendations in the Call-to-Action including strategies to promote access to and availability of physical activity opportunities and healthy food options within communities, advance the use of standardized treatment approaches and guideline-recommended care, to promote the use of healthcare teams to manage hypertension, and to empower and equip patients to use self-measured BP monitoring and medication adherence strategies. While the current review identified numerous cost-effective methods to achieve the Surgeon General's recommendations for improving BP control, future work should determine the cost-effectiveness of the 2017 American College of Cardiology and American Heart Association Hypertension guidelines, interventions to lower therapeutic inertia, and optimal team-based care strategies, among other areas of research. Economic evaluation studies should also be prioritized to generate more comprehensive data on how to provide efficient and high value care to improve BP control.

Improving the Accuracy in Classification of Blood Pressure from Photoplethysmography Using Continuous Wavelet Transform and Deep Learning.

Background Continuous wavelet transform (CWT) based scalogram can be used for photoplethysmography (PPG) signal transformation to classify blood pressure (BP) with deep learning. We aimed to investigate the determinants that can improve the accuracy of BP classification based on PPG and deep learning and establish a better algorithm for the prediction. Methods The dataset from PhysioNet was accessed to extract raw PPG signals for testing and its corresponding BPs as category labels. The BP category of normal or abnormal followed the criteria of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guidelines. The PPG signals were transformed into 224 ∗ 224 ∗ 3-pixel scalogram via different CWTs and segment units. All of them are fed into different convolutional neural networks (CNN) for training and validation. The receiver-operating characteristic and loss and accuracy curves were used to evaluate and compare the performance of different methods. Results Both wavelet type and segment length could affect the accuracy, and Cgau1 wavelet and segment-300 revealed the best performance (accuracy 90%) without obvious overfitting. This method performed better than previously reported MATLAB Morse wavelet transformed scalogram on both of our proposed CNN and CNN-GoogLeNet. Conclusions We have established a new algorithm with high accuracy to predict BP classification from PPG via matching of CWT type and segment length, which is a promising solution for rapid prediction of BP classification from real-time processing of PPG signal on a wearable device.

Thoracic Aortic Calcification and Pre-Clinical Hypertension by New 2017 ACC/AHA Hypertension Guidelines.

The recently revised 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension (HTN) guidelines employ a lower blood pressure threshold to define HTN, aiming for earlier prevention of HTN-related cardiovascular diseases (CVD). Thoracic aortic calcification (TAC), a new surrogate marker of aging and aortic medial layer degeneration, and different stages of HTN, according to the 2017 ACC/AHA HTN guidelines, remain unknown. We classified 3022 consecutive asymptomatic individuals enrolled into four HTN categories using the revised 2017 ACC/AHA guidelines: normal blood pressure (NBP), elevated blood pressure (EBP), and stage 1 (S1) and stage 2 (S2) HTN. The coronary artery calcification score and TAC metrics (total Agaston TAC score, total plaque volume (mm3), and mean density (Hounsfield units, HU)) were measured using multi-detector computed tomography. Compared to NBP, a graded and significant increase in the TAC metrics was observed starting from EBP and S1 and S2 HTN, using the new 2017 ACC/AHA guidelines (NBP as reference; all trends: p < 0.001). These differences remained consistent after being fully adjusted. Older age (>50 years), S1 and S2 HTN, prevalent diabetes, and chronic kidney disease (<60 mL/min/1.73 m2) are all independently contributing factors to higher TAC risk using multivariate stepwise logistic regressions (all p ≤ 0.001). The optimal cutoff values of systolic blood pressure, diastolic blood pressure, and pulse pressure were 121, 74, and 45 mmHg, respectively, for the presence of TAC after excluding subjects with known CVD and ongoing HTN medication treatment. Our data showed that the presence of TAC starts at a stage of elevated blood pressure not categorized as HTN from the updated 2017 ACC/AHA hypertension guidelines.

OPTIMAL THRESHOLDS FOR AMBULATORY BLOOD PRESSURE IN PATIENTS WITH HIGH CARDIOVASCULAR RISK

Objective: Recent 2017 American College of Cardiology/American Heart Association hypertension guideline suggested new ambulatory blood pressure (ABP) thresholds, however there are arguments whether it is optimal for defining hypertension. The objective of this study was to find optimal ABP thresholds for outcomes especially in patients with high cardiovascular risk. Design and method: From the Cardiovascular and Metabolic Disease Etiology Research Center – High Risk Cohort (CMERC-HI), 2026 patients who had 24-hour ABP monitoring data were selected. Baseline 24-hour ABP, daytime ABP, nighttime ABP, morning ABP threshold were determined separately using Cox proportional hazard model with propensity scores adjustment. The composite of cardiovascular disease (CVD) outcomes (hospitalization with MI, stroke, or heart failure) and all-cause mortality were primary end-points of this study. Results: A total of 2026(median age, 60 years, 52.6% male) subjects were analyzed in this study. Median follow-up was 3.4 years. There were 54 CVD outcomes and all-cause mortality (8.1 per 1000 person-years). Compared to 24-hour ABP &lt;135/85 mmHg, 24-hour ABP more than 135/85 mmHg was associated with significantly poor outcomes (HR 1.49, 95% CI, 1.02–2.17). However, 24-hour ABP more than 130/80 mmHg and 24-hour ABP more than 125/75 were not associated with significantly higher risk. For daytime ABP, the threshold of 140/90 mmHg was significantly related to higher risk of CVD outcomes or death, (HR 1.78, 95% CI, 1.04–3.05) rather than ABP 135/85 mmHg or 130/80 mmHg. For nighttime ABP, no cut-off level other than 125/75 mmHg (HR 1.58, 95% CI, 1.08–2.32) was statistically meaningful. There was no adequate threshold for morning ABP in this analysis. Conclusions: In patients with high risk for CVD, 135/85mmHg for 24hr-ABP, 140/90 mmHg for daytime ABP, 125/75 mmHg for nighttime ABP seemed to be the threshold associated with increased outcomes. The BP threshold suggested by the ACC/AHA guideline was not significantly associated with increased outcomes.

Blood pressure and long-term subclinical cardiovascular outcomes in low-risk young adults: Insights from Hanzhong adolescent hypertension cohort.

Stage 1 hypertension, newly defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guideline, has been the subject of significant interest globally. This study aims to assess the impact of the new blood pressure (BP) stratum on subsequent subclinical cardiovascular outcomes in low‐risk young adults. This longitudinal study consisted of 1020 young adults (47.7% female; ages 18–23 years) free of cardiovascular disease from the Hanzhong Adolescent Hypertension Cohort with up to 25‐year follow‐up since 1992–1995. Outcomes were available through June 2017. Young adults with stage 1 hypertension accounted for 23.7% of the cohort. When it comes to middle adulthood, subjects with early life stage 1 hypertension were more likely to experience BP progression, and they had a 1.61‐fold increased risk of high‐risk brachial‐ankle pulse wave velocity (baPWV) and a 2.92‐fold risk of left ventricular hypertrophy (LVH) comparing with their normotensive counterparts. Among participants without any active treatment in midlife, the risk associated with stage 1 hypertension for BP progression was 2.25 (95% confidence interval [CI] = 1.41–3.59), high‐risk baPWV was 1.58 (95% CI = 1.09–2.79), LVH was 2.75 (95% CI = 1.16–6.48), and subclinical renal damage (SRD) was 1.69 (95% CI = 1.02–2.82) compared with the normal BP group. Overall, young adults with stage 1 hypertension had significantly higher risks for midlife subclinical cardiovascular outcomes than normotensive subjects. BP management targeting low‐risk young adults is of importance from both clinical and public health perspectives.

758 Hypertensive disease of pregnancy (HDP) among high risk women with stage 1 hypertension

To evaluate HDP in high risk women with stage 1 hypertension (SBP 130-139 mmHg or DBP 80-89 mmHg) as defined by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guidelines. Previous investigations of low risk populations have correlated stage 1 hypertension with increased risk of poor obstetric outcomes, however high risk women have not been studied. We performed a secondary analysis of the "Low-dose aspirin to prevent preeclampsia in women at high risk" dataset, a multicenter randomized trial investigating aspirin (ASA) for the prevention of preeclampsia. High risk women with a diagnosis of insulin dependent diabetes (IDDM), chronic hypertension (CHTN), multifetal gestations (MG) or a history of preeclampsia (Hx Pre) who met criteria for stage 1 HTN at an initial prenatal visit between 13-26 weeks were randomized to baby aspirin (ASA) or placebo and compared to normotensive controls. The primary outcome was hypertensive disease in pregnancy (HDP) defined as gestational HTN, preeclampsia, and preeclampsia with severe features. Risk ratios and 95% CI were calculated. 2,053 high risk women were evaluated. 446 participants met criteria for stage 1 HTN and were compared to 1,309 normotensive controls. Among those in the placebo group, women with IDDM (RR 2.4 [1.6-3.5]), CHTN (RR 1.8 [1.1-3.0]) and Hx Pre (RR 2.0 [1.5-2.7]) demonstrated increased risk of HDP with a diagnosis of stage 1 HTN. Those with a history of preeclampsia and stage 1 HTN demonstrated increased risk for HDP in both the placebo and ASA group. ASA seemed to be effective in prevention of HDP for women with IDDM or CHTN. In patients with preexisting risk factors, stage 1 HTN at initial prenatal visit was an additive risk factor for hypertensive disease in pregnancy. ASA proves effective at preventing HDP in women with IDDM and CHTN who met criteria for stage 1 hypertension.

Age and sex specific target of blood pressure for the prevention of cardiovascular event among the treatment naive hypertensive patients

The time at which hypertension treatment should be initiated for different age groups and sexes remains controversial. We aimed to determine whether the association between blood pressure (BP) and major adverse cardiovascular events (MACE) varies with age and sex. This study enrolled 327,328 subjects who had not taken antihypertensive medication in the Korean National Health Service-National Health Screening Cohort between 2002 and 2003. Participants were categorized into four groups according to 2017 American College of Cardiology/American Heart Association hypertension guideline. Primary outcome was MACE characterized by cardiovascular mortality, myocardial infarction, unstable angina, and stroke. During a 10-year follow-up, a significant increase in MACE risk was observed from the stage 1 hypertension group (hazard ratio [HR], 1.23; 95% CI 1.15–1.32; P < 0.001) in time-varying Cox analysis. This relationship was persistent in subjects aged < 70 years, but increased MACE risk was observed only in the stage 2 hypertension group in ≥ 70 years (HR, 1.52; 95% CI 1.32–1.76, P < 0.001). When categorized as per sex, both men and women showed significant MACE risk from stage 1 hypertension. However, on comparing the sexes after stratifying by age, a significantly increased risk of MACE was shown from stage 1 hypertension in men aged < 50 years, but from stage 2 hypertension in men aged ≥ 50 years. Meanwhile, increased MACE risk was observed from stage 2 hypertension in women aged < 60 years, but from stage 1 hypertension in women aged ≥ 60 years. Thus, young male subjects had higher MACE risk than young female subjects, but this difference gradually decreased with age and there was no difference between sexes in subjects aged ≥ 70 years. Therefore, our results suggest that hypertension treatment initiation may need to be individualized depending on age and sex.

Association of Hypertension According to New American College of Cardiology/American Heart Association Blood Pressure Guidelines With Incident Dementia in the ARIC Study Cohort.

BackgroundThe impact of the new 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline on dementia risk at the population level has not been evaluated.Methods and ResultsWe studied dementia‐free participants in the ARIC (Atherosclerosis Risk in Communities) Study cohort in 1987 to 1989. Hypertension was defined by 2003 Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and 2017 ACC/AHA guidelines using blood pressure measured at baseline. Dementia was defined using adjudicated consensus diagnoses, informant telephone interviews, and discharge codes from hospitalizations and death certificates. Cox regression estimated hazard ratios (HRs) for dementia and 95% CIs by hypertension categories, adjusting for confounders. Population attributable fraction of dementia was calculated by hypertension categories. Among 13 971 participants followed up for a median of 23 years, 1381 dementia cases were identified. Prevalence of hypertension was 34% and 48%, according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and ACC/AHA criteria, respectively. HRs (95% CIs) compared with normal blood pressure, according to ACC/AHA categories, were 1.35 (1.12–1.61) for elevated blood pressure, 1.28 (1.07–1.52) for hypertension stage 1, and 1.36 (1.18–1.57) for hypertension stage 2. Population attributable fractions (95% CIs) of dementia from blood pressure categories were 3% (1%–5%), 3% (1%–5%), and 9% (4%–14%), respectively. Population attributable fractions (95% CIs) using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure categories were 6% (3%–9%) for prehypertension, 0% (−2% to 2%) for hypertension stage 1, and 9% (5%–13%) for hypertension stage 2.ConclusionsRisk of dementia increased across hypertension categories defined by ACC/AHA guidelines. The population impact on dementia incidence using ACC/AHA categories was similar to the impact of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.