Impacts of the New 2017 ACC/AHA Hypertension Guideline on the Prevalence of Brachial Hypertension and Its Concordance with Central Hypertension

Abstract

Objectives: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline lowers the blood pressure (BP) thresholds for defining brachial hypertension. We therefore aimed to investigate how the new guideline influences the prevalence of brachial hypertension and whether it improves the identification of central hypertension in an Asian national representative population.

Methods: A total of 2,742 adults older than 19 years participated in the 2013-2016 National Nutrition and Health Survey in Taiwan. Central and brachial BPs were simultaneously measured twice and averaged using a cuff-based stand-alone central BP monitor purporting to measure invasive central BP (type II device). Brachial hypertension was defined by brachial systolic/diastolic BP ≥ 130 or 80 mm Hg or using antihypertensive medication, and central hypertension was defined by central systolic/diastolic BP ≥ 130 or 90 mm Hg or using antihypertensive medication.

Results: The national weighted prevalence rates of brachial hypertension according to the 2017 AHA/ACC guideline were 48.7% in men and 30.7% in women. The prevalence of brachial hypertension increased by 18.8% in men and 9.4% in women, when compared with the prevalence defined by the conventional thresholds of brachial systolic/diastolic BP ≥ 140 or 90 mm Hg. In comparison with the conventional criteria, the new hypertension criteria had a higher sensitivity (93.0% vs. 77.4%) and a lower specificity (86.7% vs. 99.6%) for detecting central hypertension.

Conclusions: Adoption of the 2017 AHA/ACC BP thresholds substantially increases the prevalence of brachial hypertension, especially in men, and identifies over 90% of those with central hypertension at the expense of lesser specificity.

Keywords: blood pressure; hypertension; measurement; prevalence.