High Blood Pressure In Adults Research Articles

Ideal Blood Pressure in Patients With Atrial Fibrillation

BackgroundThe 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for High Blood Pressure in Adults redefined hypertension as systolic blood pressure (BP) ≥130 mm Hg or diastolic BP ≥80 mm Hg. The optimal BP for patients with atrial fibrillation (AF) is uncertain. ObjectivesThe goal of this study was to investigate the impacts of the 2017 ACC/AHA guideline and to determine the ideal BP threshold for the management of high BP in patients with AF. MethodsThis study analyzed data for 298,374 Korean adults with oral anticoagulant–naive, nonvalvular AF obtained from the National Health Insurance Service database from 2005 to 2015. ResultsAccording to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure guideline, 62.2% of the individuals in our sample had hypertension. After applying the 2017 ACC/AHA guideline, 79.4% had hypertension, including 17.2% with newly redefined hypertension (130 to 139/80 to 89 mm Hg). Those with newly redefined hypertension had greater risks of major cardiovascular events (hazard ratio: 1.07; 95% confidence interval: 1.04 to 1.10; p < 0.001), ischemic stroke, intracranial hemorrhage, and heart failure admission, compared with nonhypertensive patients (<130/80 mm Hg). Among patients with AF undergoing hypertension treatment, patients with BP ≥130/80 mm Hg or <120/80 mm Hg were at significantly higher risks of major cardiovascular events than patients with BP of 120 to 129/<80 mm Hg. ConclusionsPatients with AF and newly redefined hypertension according to the 2017 ACC/AHA guideline were at higher risk of major cardiovascular events, suggesting that the new BP threshold is beneficial for timely diagnosis and intervention. BP of 120 to 129/<80 mm Hg was the optimal BP treatment target for patients with AF undergoing hypertension treatment.

Association between age at menarche and blood pressure in adulthood: is obesity an important mediator?

We investigated the association between age at menarche, and adiposity and blood pressure in adulthood, as well as the mediation effects of adiposity on the relationship between age at menarche and blood pressure. This was a nationally representative survey conducted in Brazil in 2013 (Brazilian Health Survey). The participants included 33,715women between 18 and 100 years old. Age at menarche was self-reported and outcomes (body mass index [BMI], waist circumference, and blood pressure) were objectively measured. As covariates, data on chronological age, race, educational status, tobacco smoking, leisure physical activity, TV viewing, sodium consumption, alcohol drinking, menopause status, and antihypertensive medication use were obtained by questionnaires. Negative and linear relationships were observed between age at menarche and adiposity indicators. Early maturers presented a greater prevalence of obesity (waist circumference: 56.3% [54.0-58.7] vs. 52.4% [51.4-53.5], BMI: 32.4% [30.2-34.6] vs. 25.1% [24.2-26.0]) than on time/late maturers. Age at menarche was significantly inversely related to blood pressure and adiposity in adulthood (p < 0.05), although these associations were weaker than the association between obesity and early menarche. Adiposity indicators mediated the relationship between age at menarche, and systolic (partly) and diastolic (fully) blood pressure. In conclusion, early maturation is related to obesity and higher blood pressure in adulthood. Obesity is an important mediator of the influence of early maturation on high blood pressure in women.

First look at new 2018 joint ESH/ESC Guidelines on diagnosis and management of hypertension

Systemic hypertension (HTN) is the most prevalent non-communicable disease and the leading cause for major cardiovascular events, renal failure and cognitive decline. The World Health Organization showed that HTN is a key area of concern for healthcare and identified this condition as one of the primary targets for intervention to reduce global morbidity and mortality. The hard-hitting AHA/ACC Guidelines on management of High blood pressure in adults published in 2017 shocked medical community and enforced reconsidering overall significance HTN once again due to the large pool of newly diagnosed individuals and higher healthcare costs. Ensuing debates around Task Force committee opinions were fomenting at every scientific session related to cardiac diseases throughout first half-year 2018 and beyond the lecture halls as well. Thus all attendees at the 28th European Congress on Hypertension and Cardiovascular Protection held in Barcelona, Spain in June were captivated with the European expert’s presented preview of the new 2018 ESH/ESC joint clinical Guidelines on diagnosis and management of HTN. This short review highlights the bullet points presented before fulltext publication. The chapters on diagnosis, risk stratification, blood pressure treatment target ranges had undergone minor but crucial corrections. Key changes include medical treatment of uncomplicated HTN and drug therapy in special groups with major comorbidities, management of resistant HTN, device-based HTN therapy and adherence interventions.

Self-reported depressive symptoms in adolescence increase the risk for obesity and high BP in adulthood

BackgroundNegative psychological symptoms may impact cardiovascular (CV) risk factors such as obesity and abnormal blood pressure (BP). Currently, a third of the US population is obese (BMI ≥ 30 kg/m2) and nearly half have high BP (BP > 120/80 mmHg). This research aims to investigate whether self-reported depressive symptoms in adolescence affect adulthood obesity and high BP. MethodsWe leveraged the data from a representative sample of US individuals collected by the National Longitudinal Study of Adolescent to Adult Health (Add Health). We identified the survey questions pertaining to self-reported depressive symptoms in over 14,000 adolescents. Based on their follow-up health test in adulthood, we evaluated the impact of adolescent depressive symptoms on adulthood obesity and high BP by adjusting for socio-demographic, socio-economic and adolescent health status. ResultsThis study reveals a high prevalence of obesity (36%) and high BP (66%) among young US adults with an average age of only 28 years. Excessive moodiness in adolescence significantly impacted the development of obesity in early adulthood (p-value <0.001). ‘Feeling sad’ on most days in adolescence significantly increases the risk of obesity (p-value 0.01) and high BP (p-value <0.03) in early adulthood. ConclusionsThis study demonstrates self-reported moodiness in adolescence to be a significant predictor of obesity in adulthood. Feeling sad on most days increase the subsequent risk for high BP. Early intervention may improve lifestyle and CV outcomes.

Estimated Change in Prevalence of Hypertension in Nepal Following Application of the 2017 ACC/AHA Guideline

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults lowered the systolic and diastolic blood pressure thresholds for hypertension to 130 and 80 mm Hg, respectively. This represents a reduction of 10 mm Hg in both systolic and diastolic blood pressure levels used to define hypertension compared with previous guidelines, such as the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). To estimate the prevalence of hypertension among adults aged 18 years or older in Nepal per the 2017 ACC/AHA guideline and to determine the absolute difference in hypertension prevalence comparing the 2017 ACC/AHA and JNC 7 guidelines. The cross-sectional analysis used data from the population-based 2016 Nepal Demographic and Health Survey. Data were collected from June 2016 to January 2017 using a multistage stratified sampling procedure that was applied in urban and rural areas, using wards as the primary sampling units. Individuals aged 15 years or older from selected households were interviewed. The survey had an overall response rate of approximately 97%. The primary outcome was the prevalence of hypertension. Blood pressure was measured 3 times for each participant with 5-minute intervals between. Hypertension was present if blood pressure was greater than or equal to 130/80 mm Hg for the 2017 ACC/AHA guideline, and greater than or equal to 140/90 mm Hg for the JNC 7 guideline. Among 13 519 participants (median [interquartile range] age, 38 [26-53] years; 7821 [57.9%] female), 44.2% (95% CI, 43.4%-45.0%; n = 5977) had hypertension according to the 2017 ACC/AHA guideline compared with 21.2% (95% CI, 20.5%-21.9%; n = 2869) by the JNC 7 guideline. The new prevalence was associated with an absolute increase of 23.0% (95% CI, 22.3%-23.7%) from the JNC 7 guideline. When estimating the proportion of hypertension by background characteristics, the new 2017 ACC/AHA guideline definition increased the prevalence to 50% or greater for some categories, with the highest prevalence among those with a body mass index (calculated as weight in kilograms divided by height in meters squared) greater than or equal to 30 (71.6%; 95% CI, 67.7%-75.3%) and between 25 and 29.9 (62.1%; 95% CI, 60.1%-64.1%). For adults in Nepal, the new 2017 ACC/AHA guideline reveals a greater estimated prevalence of hypertension compared with the JNC 7 guideline. Because of the public health significance of hypertension, higher prevalence rates confirm the importance of developing effective prevention and control methods in this country.

7 IMPACT OF THE 2017 AMERICAN COLLEGE OF CARDIOLOGY/AMERICAN HEART ASSOCIATION HIGH BLOOD PRESSURE GUIDELINE ON MIDDLE-AGED POPULATION

Background: The newly released 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults provides comprehensive recommendations for the definition of hypertension, and systolic and diastolic blood pressure thresholds for initiation of antihypertensive medication. Objective: To determine the prevalence of hypertension and implications of recommendations for antihypertensive medication among middle-aged adults using criteria from the 2017 ACC/AHA and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) guidelines. Methods: We analyzed data of 252 participants restricted to 36–55 years of age pooling at Puskesmas Kecamatan Pasar Minggu who have completed standard interviewing procedures and examinations. For each participant, blood pressure measurements were taken following a standardized protocol. History of CVD was defined by self-report of prior diagnosis, and those without history of CVD, 10-year predicted risk was calculated. Results: The overall crude prevalence of hypertension among middle-aged adults was 69.8% (95% confidence interval [CI] 63.8–75.4%) and 45.6% (95% CI 39.4–52%) according to the 2017 ACC/AHA and JNC 7 guidelines, respectively, and antihypertensive medication was recommended for 51.6 % (95% CI 45.2–57.9%) and 45.6 % (95% CI 39.4–52%) of the adults, respectively. Non-pharmacological intervention is suggested for 18.3% of middle-aged adults with hypertension who are not recommended antihypertensive medication according to the 2017 ACC/AHA guideline. Conclusions: The 2017 ACC/AHA guideline results in a substatial increase in the prevalence of hypertension compared with the JNC 7 guideline. However, the percentage of middle-aged adults recommended for antihypertensive medication only showed a modest increase.

The new 2017 ACC/AHA guideline for classification of hypertension: changes in prevalence of hypertension among adults in Bangladesh.

We analyzed the Bangladesh Demographic and Health Survey 2011 data to examine absolute differences in hypertension prevalence according to the hypertension definition of the "2017 American College of Cardiology/American Heart Association (2017 ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults" and "Seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7)" 2003 guidelines. Among 7839 participants ≥35 years, the JNC7 and 2017 ACC/AHA classified 25.7% (95% confidence interval (CI): 24.5-27.0%) and 48.0% (95% CI: 46.4-49.7%) people hypertensive, respectively. The JNC7 prevalence was 19.4% (95% CI: 18.0-21.0%) among males and 31.9% (95% CI: 30.1-33.6%) among females. The prevalence was 41.4% (95% CI: 39.4-43.5%) among males and 54.5% (95% CI: 52.4-56.4%) among females as per the 2017ACC/AHA guideline. From JNC7 to 2017 ACC/AHA, the overalldifference in prevalence was 22.3% (95% CI: 19.8-24.8%). Males and females had similar differences, 22.0% (95% CI: 18.3-25.7%) and 22.6% (95% CI: 19.4-26.0%), respectively. As per the 2017 ACC/AHA guideline, >50% prevalence was observed among people with body mass index ≥25 kg/m2, college-level education, co-morbid diabetes, richest wealth quintile, females, age ≥55 years, urban residence, or living in Khulna, Rangpur or Dhaka divisions; the absolute difference was >20% in most categories. We found a substantial increase in the prevalence of hypertension due to change in blood pressure thresholds as per the 2017 ACC/AHA guideline. We recommend conducting more comprehensive population-based studies to estimate the recent burden of hypertension in Bangladesh. Future studies should estimate similar prevalence in other countries.

Correction to: 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

In the article by Whelton et al, “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines,” which published ahead of print on November 13, 2017, and appeared in the June 2018 issue of the journal ( Hypertension . 2018;71:1269–1324. DOI: 10.1161/HYP.0000000000000066), several corrections were needed. 1. On page 1269, in the author list, “FACC” has been removed after Dr. Giddings’ name. 2. On page 1270, in the Table of Contents and on page 1295, the 9.5. heading read, “9.5. Peripheral Arterial Disease.” It has been updated to read, “9.5. Peripheral Artery Disease.” It has also been updated on page 1303 in Table 22 and on page 1304 in Table 23. 3. On page 1276, in the footnote for Table 5, second paragraph, last sentence, the reference 3 citation has been removed from the end of the sentence. 4. On page 1278, the heading “4.3. Ambulatory BP Monitoring” has been deleted. The heading “4.4. Masked and White Coat Hypertension” now reads, “4.3. Masked and White Coat Hypertension.” 5. On page 1279, Figure 1, bottom row, needed the following changes: 6. On page 1280, Figure 2, bottom row, the second box from the left read, “Continue current therapy (Class IIa).” It has been updated to read, “Continue current therapy”; the Class of Recommendation color has been removed. 7. On page 1284, in Table …

Correction to: 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

In the article by Whelton et al, “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines,” which published ahead of print on November 13, 2017, and appeared in the June 2018 issue of the journal ( Hypertension . 2018;71:e13–e115. DOI: 10.1161/HYP.0000000000000065), several corrections were needed. 1. On page e13, in the author list, “FACC” has been removed after Dr. Giddings’ name. 2. On page e14, in the Table of Contents and on page e57, the 9.5. heading read, “9.5. Peripheral Arterial Disease.” It has been updated to read, “9.5. Peripheral Artery Disease.” It has also been updated on page e76 in Table 22 and on page e77 in Table 23. 3. On page e20, in the footnote for Table 5, second paragraph, last sentence, the reference 12 citation has been removed from the end of the sentence. 4. On page e27, Figure 1, bottom row, needed the following changes: 5. On page e28, Figure 2, bottom row, the second box from the left read, “Continue current therapy (Class IIa).” It has been updated to read, “Continue current therapy”; the Class of Recommendation color has been removed. 6. On page e33, in Table 14, the text in the first column, last row read, “Angiogenesis inhibitor (eg, bevacizumab) and tyrosine kinase inhibitors (eg, sunitinib, sorafenif).” It has been updated to read, “Angiogenesis inhibitor (eg, …

Correction to: Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

In the article by Reboussin et al, “Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines,” which published ahead of print on November 13, 2017, and appeared in the June 2018 issue of the journal ( Hypertension . 2018;71:e116-e135. DOI: 10.1161/HYP.0000000000000067), several corrections were needed. 1. On page e117, in the Table of Contents, …

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve cardiovascular health. In 2013, the National Heart, Lung, and Blood Institute (NHLBI) Advisory

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

Hypertension guideline update: A new guideline for a new era.

In the United States, hypertension affects about one-third of adults and contributes to one out of every seven deaths. Evidence-based treatment is associated with reductions in incidence of stroke, myocardial infarction, and heart failure as well as associated disability and death. This article reviews the ACC/AHA Task Force on Clinical Practice Guidelines' 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Key changes include reclassification of BP stages and lowering of hypertension treatment goals.

Study on relationship between prevalence or co-prevalence of risk factors for cardiovascular disease and blood pressure level in adults in China

Objective: To study the relationship between blood pressure level and major risk factors for cardiovascular diseases in adults in China. Methods: A total of 179 347 adults aged ≥18 years were recruited from 298 surveillance points in 31 provinces in China in 2013 through complex multistage stratified sampling. The survey included face to face interview and physical examination to collect information about risk factors, such as smoking, drinking, diet pattern, physical activity, overweight or obesity, and the prevalence of hypertension. The blood pressure was classified into 6 levels (ideal blood pressure, normal blood pressure, normal high blood pressure and hypertension phase Ⅰ, Ⅱ and Ⅲ). The relationship between the prevalence or co-prevalence of risk factors for cardiovascular disease and blood pressure was analyzed. Results: The adults with ideal blood pressure, normal blood pressure, normal high pressure, hypertension phase Ⅰ, Ⅱ and Ⅲ accounted for 36.14%, 22.77%, 16.22%, 16.43%, 5.97% and 2.48%, respectively. Among them, the blood pressure was higher in men, people in Han ethnic group and those married, and the blood pressure was higher in those with older age, lower income level and lower education level, the differences were all significant (P<0.05). Whether taking antihypertensive drug or not, co-prevalence of risk factors influenced the blood pressure levels of both sexes (P<0.05), and the blood pressure levels of those taking no antihypertensive drug was influenced more by the co-prevalence of risk factors. Finally, multiple logistic analysis showed that the risks for high blood pressure in adults with 1, 2 and ≥3 risk factors were 1.36, 1.79 and 2.38 times higher, respectively, than that of the adults without risk factor. Conclusion: The more the risk factors for cardiovascular disease in adults, the higher their blood pressure were. It is necessary to conduct comprehensive behavior intervention targeting ≥ 2 risk factors for the better control of blood pressure in general population.

Could 130/80 mm Hg Be Adopted as the Diagnostic Threshold and Management Goal of Hypertension in Consideration of the Characteristics of Asian Populations?

See related article, pp e13–e115 This commentary discusses the practical feasibility of the 2017 American Heart Association/American College of Cardiology (AHA/ACC) guidelines1 for the management of hypertension and the ideal direction of blood pressure (BP) prevention, detection, evaluation, and management for achieving a goal of zero cardiovascular events in Asia. Hypertension is a massive global burden on healthcare that indiscriminately affects both high- and low-income countries. However, there are significant ethnic differences in the determinants of hypertension and cardiovascular disease.2,3 The 2017 AHA/ACC guidelines for the prevention, detection, evaluation, and management of high BP in adults changed the diagnostic threshold and the management goal of BP from 140/90 to 130/80 mm Hg. This change in the BP threshold raises 2 important practical considerations for the treatment of hypertension in Asian countries. Because of the stronger BP-dependent characteristics of cardiovascular disease in Asians compared with Westerners, the reduction to a BP goal of 130/80 mm Hg is right in the front of the figure universal management of hypertension. However, because of various cultural and socioeconomic factors specific to Asian countries, the BP control in these countries was not sufficient even when the 140/90 mm Hg threshold was used. The shift of the BP threshold to 130/80 mm Hg level will significantly increase the number of patients with hypertension or uncontrolled hypertension to ≈50% of all Asian adults living in Asian countries. The goal of the management of hypertension is not reducing BP per se but rather preventing cardiovascular events. From this view point, earlier diagnosis and treatment of hypertension is effective for reducing cardiovascular events later in life. The diagnosis of hypertension is based on the average of …

New guidelines, and a new hypertensive population How to select women for menopausal hormone therapy

The 2017 ACC/AHA/AAPA/ABC/ACPM/ AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults published in November 2017(1) designates new categories of blood pressure in adults: Normal &lt;120/140/&gt;90 mm Hg. A previous report based on blood pressure readings in 19.1 million adults pooled from 1 479 studies found that the global age-standardized prevalence of raised blood pressure was 24.1% (21.4–27.1) in men and 20.1% (17.8–22.5) in women in 2015(2). The Peruvian Tornasol II study on Risk Factors for Cardiovascular Diseases reported in 2011 a prevalence of 27.3% for arterial hypertension(3), showing an increase compared to the previous value of 23.7% in 2006(4).

Phthalate exposure and high blood pressure in adults: a cross-sectional study in China.

Widespread phthalate exposure has been recently documented and is hypothesized to increase blood pressure (BP) in humans. However, current studies have provided inconclusive evidence for an association between phthalate exposure and BP. Human epidemiologic studies on the topic remain lacking. Therefore, this study aims to examine the association between serum phthalate concentrations and BP in a Chinese population. We measured several parameters of BP (systolic BP, diastolic BP, total cholesterol, and triglyceride) and the concentrations of 16 phthalates (dimethyl phthalate (DMP), diethyl phthalate, diisobutyl phthalate, dibutyl phthalate (DBP), bis (2-methoxyethyl) phthalate, bis (4-methyl-2-pentyl) phthalate, bis (2-ethoxyethyl) phthalate, diamyl phthalate, dihexyl phthalate, benzyl butyl phthalate, bis (2-nbutoxyethyl) phthalate (DBEP), dicyclohexyl phthalate, bis (2-ethyl hexyl) phthalate (DEHP), diisononyl phthalate, diphenyl phthalate, and di-n-octyl phthalate) in the serum of 474 adults recruited from a primary health care clinic. The relationship between serum phthalate concentrations and BP parameters was assessed with multivariate linear regressions. DBP was the most ubiquitous and dominant contaminant in the study population. The systolic BP of subjects in the median-exposure DEHP group significantly increased by 2.96mmHg (p < 0.05) relative to that of subjects in the low-exposure group. Significant positive dose-related associations of DMP and DBEP with the levels of total cholesterol in serum (p for trend < 0.05) were also found. These associations persisted even when considering exposure to multiple phthalates. Our results suggested that phthalate exposure might increase BP in adults. However, our findings warrant further studies in a larger and more general population.

Prevalence and treatment of hypertension in China: impacts of 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline

The definition, recommended treatment thresholds and targets of hypertension have been updated in the recent 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. However, the impacts of this guideline on Chinese population are currently unknown. In this study, we aim to provide updated data in China using criteria from the updated guideline. A multistage, stratified sampling method was used to obtain a representative sample of 50,171 adults aged 18 years and above. Hypertension was defined as an average systolic blood pressure ≥130 mm Hg, or an average diastolic blood pressure ≥80 mm Hg, or self-reported use of antihypertensive medications in past 2 weeks. The weighted prevalence of hypertension was 60.1% (95% confidence interval [CI] 59.3%–61.0%). The treatment rate and recommended treatment rate were 16.8% (95% CI 16.1%–17.6%) and 53.7% (95% CI 52.6%–54.9%), respectively; the gap was more prominent among men and participants from rural areas. Hence, the adoption of the 2017 ACC/AHA guideline will lead to a substantial increase in both prevalence and number of patients needing treatment in China. The applicability of this guideline should be carefully evaluated based on evidence from Chinese population.

What is new in Hypertension of Mexico 2018? -Impact of the new classification of high blood pressure in adults from American College of Cardiology/American Heart Association (ACC/AHA)

What is new in Hypertension of Mexico 2018? -Impact of the new classification of high blood pressure in adults from American College of Cardiology/American Heart Association (ACC/AHA)

Incidence of cardiovascular disease in individuals affected by recent changes to US blood pressure treatment guidelines.

We evaluated the incidence of cardiovascular disease (CVD) in individuals whose blood pressure (BP) management strategy would change with adoption of recent US hypertension guidelines in two large, community-based cohorts with different racial and geographic compositions: the Framingham and Jackson Heart Studies (FHS and JHS). We assigned 11 237 FHS (mean age 46, 53% women) and 2948 JHS (mean age 55, 69% women) participants free of CVD and chronic kidney disease to one of five categories representing different treatment recommendations between 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee and The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines. Absolute incidence rates (incidence rate; per 1000 person-years) and multivariable-adjusted hazard ratios were calculated for each group; cohort-specific results were combined using fixed effect meta-analysis. CVD events occurred in 1047 FHS and 230 JHS participants during mean follow-up times of 11 and 8.9 years, respectively. Compared with individuals without hypertension, those with BP 140-149/<90 mmHg had increased risk for CVD regardless of treatment status [hazard ratio for untreated BP 140-149/<90 mmHg 1.96, 95% confidence interval (CI) 1.40-2.75; hazard ratio for treated BP 140-149/<90 mmHg 3.37, 95% CI 2.37-4.78]. The risk for those with treated BP 140-149/<90 mmHg was consistent in those aged at least 60 years (hazard ratio: 2.61, 95% CI 1.75-3.90). Statistical power was limited to evaluate the effect of diabetes. Individuals with treated BP 140-149/<90 mmHg have increased risk of CVD compared with those without hypertension including in participants at least 60 years. The 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee recommendations to treat BP levels less aggressively may be associated with substantial residual CVD risk.