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. 2019 Nov 1;8(11):1832.
doi: 10.3390/jcm8111832.

2017 ACC/AHA Blood Pressure Classification and Cardiovascular Disease in 15 Million Adults of Age 20-94 Years

Hokyou Lee  1   2 , So Mi Jemma Cho  3 , Jong Heon Park  4 , Sungha Park  5   6 , Hyeon Chang Kim  7   8
Affiliations

2017 ACC/AHA Blood Pressure Classification and Cardiovascular Disease in 15 Million Adults of Age 20-94 Years

Hokyou Lee et al. J Clin Med. .

Abstract

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) high blood pressure (BP) guideline lowered the cut-off for hypertension, but its age-specific association with cardiovascular disease (CVD) remains inconclusive in different populations. We evaluated the association between high BP according to the 2017 ACC/AHA guideline and CVD risks in Koreans aged 20-94 years. In a nationwide health screening cohort, we included 15,508,537 persons aged 20-94 years without prior CVD. BP was categorized into normal, elevated, stage 1 hypertension, or stage 2 hypertension. The primary outcome was a composite CVD hospitalization (myocardial infarction, stroke, and/or heart failure). Over 10 years of follow-up, CVD incidence rates per 100,000 person-years were 105.4, 168.3, 215.9, and 641.2 for normal, elevated BP, stage 1, and stage 2 hypertension, respectively. The age-specific hazard ratios of stage 1 hypertension compared to normal BP were 1.41 (1.34-1.48) at ages 20-34, 1.54 (1.51-1.57) at ages 35-49, 1.38 (1.35-1.40) at ages 50-64, 1.21 (1.19-1.24) at ages 65-79, and 1.11 (1.03-1.19) at ages 80-94 years. With the lowered BP cut-off, 130/80 mmHg, population attributable fraction for CVD was 32.2%. In conclusion, stage 1 hypertension was significantly associated with a higher CVD risk across entire adulthood. The new definition of hypertension may have a substantial population impact on primary CVD prevention.

Keywords: age-specific risk; guideline; hypertension; population attributable risk; real world data.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Age-specific CVD incidence rate according to blood pressure group. Rate per 100,000 person-years. CVD, cardiovascular disease.
Figure 2
Figure 2
Age-specific CVD and mortality risks according to blood pressure group among persons not taking antihypertensive medications. Rates per 100,000 person-years. HRs adjusted for age, sex, household income, Charlson comorbidity index, use of glucose-lowering drugs, use of lipid-lowering drugs, smoking, drinking, exercise, body mass index, fasting glucose, and total cholesterol. BP, blood pressure; CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; HT, hypertension.
Figure 3
Figure 3
Age-specific CVD and mortality risks according to continuous systolic or diastolic BP among persons not taking antihypertensive medications. Hazard ratios in solid lines and 95% confidence intervals in shades. Hazard ratios centered on 120 mmHg systolic and 90 mmHg diastolic BP using penalized spline methods (df = 4), and adjusted for age, sex, household income, Charlson comorbidity index, use of glucose-lowering drugs, use of lipid-lowering drugs, smoking, drinking, exercise, body mass index, fasting glucose, and total cholesterol. BP, blood pressure; CVD, cardiovascular disease.
Figure 4
Figure 4
Age-specific risks for myocardial infarction, stroke, heart failure, and CVD-related deaths according to blood pressure group among persons not taking antihypertensive medications. Rates per 100,000 person-years. HRs adjusted for age, sex, household income, Charlson comorbidity index, use of glucose-lowering drugs, use of lipid-lowering drugs, smoking, drinking, exercise, body mass index, fasting glucose, and total cholesterol. BP, blood pressure; CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; HT, hypertension.
Figure 5
Figure 5
Age-specific population attributable fractions for cardiovascular disease associated with ACC/AHA or JNC-7 blood pressure cut-off. Adjusted hazard ratios (full model) were used for calculating population attributable fractions. ACC/AHA = SBP ≥130 mmHg, DBP ≥80 mmHg, or medication; JNC-7 = SBP ≥140 mmHg, DBP ≥90 mmHg, medication. ACC, American College of Cardiology; AHA, American Heart Association; DBP, diastolic blood pressure; JNC-7, Seventh Report of the Joint National Committee; SBP, systolic blood pressure.
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