Impact of the 2017 ACC/AHA guideline on the prevalence of elevated blood pressure and hypertension: a cross-sectional analysis of 10 799 individuals

Mesnad Alyabsi, Reham Gaid, Ada Alqunaibet, Ahmed Alaskar, Azra Mahmud, Jahad Alghamdi, Mesnad Alyabsi, Reham Gaid, Ada Alqunaibet, Ahmed Alaskar, Azra Mahmud, Jahad Alghamdi

Abstract

Objectives: To assess the effect of the 2017 American College of Cardiology and the American Heart Association (ACC/AHA) hypertension guideline on the prevalence of elevated blood pressure (BP) and hypertension and the initiation of antihypertensive treatment, as well as the level of adherence to the BP target in the Saudi population.

Design: A cross-sectional study.

Participants: A total of 10 799 adults (≥18 years old), with three BP readings during 2017-2020 from the Saudi Biobank was used.

Primary outcome: Hypertension was defined using three sources: the Joint National Committee 7 Blood Pressure Guideline (JNC-7) guideline (systolic BP (SBP)≥140 or diastolic BP (DBP)≥90 mm Hg), the 2017 ACC/AHA guideline (SBP≥130 or DBP≥80 mm Hg) and a self-reported hypertension diagnosis.

Results: The prevalence of hypertension, according to the JNC-7 guideline, was 14.49% (95% CI 14.37 to 14.61), and the 2017 ACC/AHA, 40.77% (95% CI 40.60 to 40.94), a difference of 26.28%. Antihypertensive medication was recommended for 24.84% (95% CI 24.69 to 24.98) based on the JNC-7 guideline and 27.67% (95% CI 27.52 to 27.82) using the 2017 ACC/AHA guideline. Lifestyle modification was recommended for 13.10% (95% CI 12.47 to 13.74) of patients with hypertension who were not eligible for a pharmacological intervention, based on the 2017 ACA/AHA guideline. For patients with prescribed antihypertensive medication, 49.56% (95% CI 45.50 to 53.64) and 27.81% (95% CI 24.31 to 31.59) presented with a BP reading above the treatment goal, based on the 2017 ACA/AHA and JNC-7 guidelines, respectively. Using the two definitions, the risk factors were older age, male gender, diabetes diagnosis, increased body mass index, waist circumference and waist-to-hip ratio.

Conclusions: According to the 2017 ACC/AHA guideline, the prevalence of hypertension has increased significantly, but there was only a small increase in the proportion of patients recommended for antihypertensive treatment. A large proportion of patients with prescribed antihypertensive medication, had a BP above the target. Unless public health prevention efforts are adopted, the increased prevalence of elevated BP and hypertension will increase cardiovascular disease.

Keywords: epidemiology; hypertension; protocols & guidelines.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Zhou D, Xi B, Zhao M, et al. . Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III linked mortality study. Sci Rep 2018;8:1–7. 10.1038/s41598-018-27377-2
    1. Chan M. A global brief on hypertension. Switzerland: World Health Organization, 2013.
    1. Sudharsanan N, Geldsetzer P. Impact of coming demographic changes on the number of adults in need of care for hypertension in Brazil, China, India, Indonesia, Mexico, and South Africa. Hypertension 2019;73:770–6. 10.1161/HYPERTENSIONAHA.118.12337
    1. Lackland DT, Weber MA. Global burden of cardiovascular disease and stroke: hypertension at the core. Can J Cardiol 2015;31:569–71. 10.1016/j.cjca.2015.01.009
    1. Han M, Li Q, Liu L, et al. . Prehypertension and risk of cardiovascular diseases: a meta-analysis of 47 cohort studies. J Hypertens 2019;37:2325–32. 10.1097/HJH.0000000000002191
    1. Bolli P, Hemmelgarn B, Myers MG, et al. . High normal blood pressure and prehypertension: the debate continues. Can J Cardiol 2007;23:581–3. 10.1016/S0828-282X(07)70805-X
    1. Banach M, Michalska M, Kjeldsen SE, et al. . What should be the optimal levels of blood pressure: does the J-curve phenomenon really exist? Expert Opin Pharmacother 2011;12:1835–44. 10.1517/14656566.2011.579106
    1. Fan F, Yuan Z, Qin X, et al. . Optimal systolic blood pressure levels for primary prevention of stroke in general hypertensive adults: findings from the CSPPT (China stroke primary prevention trial). Hypertension 2017;69:697–704. 10.1161/HYPERTENSIONAHA.116.08499
    1. Deedwania P. The ongoing SAGA of optimal blood pressure level in patients with diabetes mellitus and coronary artery disease. J Am Heart Assoc 2018;7:e010752. 10.1161/JAHA.118.010752
    1. Whelton PK, Carey RM, Aronow WS, 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. J Am Coll Cardiol 2018;71:e127–248. 10.1016/j.jacc.2017.11.006
    1. Chobanian AV, Bakris GL, Black HR, et al. . Seventh report of the joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003;42:1206–52. 10.1161/01.HYP.0000107251.49515.c2
    1. Reboussin DM, Allen NB, Griswold ME, 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. J Am Coll Cardiol 2018;71:2176–98. 10.1016/j.jacc.2017.11.004
    1. Muntner P, Carey RM, Gidding S, et al. . Potential U.S. Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline. J Am Coll Cardiol 2018;71:109–18. 10.1016/j.jacc.2017.10.073
    1. Kibria GMA, Swasey K, Kc A, et al. . Estimated change in prevalence of hypertension in Nepal following application of the 2017 ACC/AHA guideline. JAMA Netw Open 2018;1:e180606. 10.1001/jamanetworkopen.2018.0606
    1. Khera R, Lu Y, Saxena A. The impact of 2017 ACC/AHA guidelines on the prevalence of hypertension and eligibility for anti-hypertensive therapy in the United States and China. bioRxiv 2017;218859.
    1. Islam JY, Zaman MM, Haq SA, et al. . Epidemiology of hypertension among Bangladeshi adults using the 2017 ACC/AHA hypertension clinical practice guidelines and joint National Committee 7 guidelines. J Hum Hypertens 2018;32:668–80. 10.1038/s41371-018-0087-5
    1. Wang D, Hatahet M, Wang Y, et al. . Multivariate analysis of hypertension in general us adults based on the 2017 ACC/AHA guideline: data from the National health and nutrition examination survey 1999 to 2016. Blood Press 2019;28:191–8. 10.1080/08037051.2019.1593042
    1. Kibria GMA, Swasey K, Choudhury A, et al. . The new 2017 ACC/AHA guideline for classification of hypertension: changes in prevalence of hypertension among adults in Bangladesh. J Hum Hypertens 2018;32:608–16. 10.1038/s41371-018-0080-z
    1. General Authority for Statistics . Demographic survey, 2016. Available:
    1. El Bcheraoui C, Basulaiman M, Wilson S, et al. . Breast cancer screening in Saudi Arabia: free but almost no takers. PLoS One 2015;10:e0119051. 10.1371/journal.pone.0119051
    1. El Bcheraoui C, Memish ZA, Tuffaha M, et al. . Hypertension and its associated risk factors in the Kingdom of Saudi Arabia, 2013: a national survey. Int J Hypertens 2014;2014:1–8. 10.1155/2014/564679
    1. Yusufali AM, Khatib R, Islam S, et al. . Prevalence, awareness, treatment and control of hypertension in four middle East countries. J Hypertens 2017;35:1457–64. 10.1097/HJH.0000000000001326
    1. Lear SA, James PT, Ko GT, et al. . Appropriateness of waist circumference and waist-to-hip ratio cutoffs for different ethnic groups. Eur J Clin Nutr 2010;64:42–61. 10.1038/ejcn.2009.70
    1. Bullano MF, Kamat S, Willey VJ, et al. . Agreement between administrative claims and the medical record in identifying patients with a diagnosis of hypertension. Med Care 2006;44:486–90. 10.1097/01.mlr.0000207482.02503.55
    1. Smith C, Kosten S. Multiple imputation: a statistical programming story, 2017. Available:
    1. von Elm E, Altman DG, Egger M, et al. . The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007;147:573–7. 10.7326/0003-4819-147-8-200710160-00010
    1. Khanam R, Ahmed S, Rahman S, et al. . Prevalence and factors associated with hypertension among adults in rural Sylhet district of Bangladesh: a cross-sectional study. BMJ Open 2019;9:e026722. 10.1136/bmjopen-2018-026722
    1. Samir KC. An age distribution story: reading into the population pyramid of Nepal. Asian Popul Stud 2014;10:121–4. 10.1080/17441730.2014.902164
    1. Kabir R, Khan HT, Kabir M. Population ageing in Bangladesh and its implication on health care. European Scientific Journal 2013;9:34–47.
    1. Arnett DK, Blumenthal RS, Albert MA, et al. . 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;74:e177–232. 10.1016/j.jacc.2019.03.010
    1. Stefani L, Mascherini G, Tosi B, et al. . Hypertension today: role of sports and exercise medicine. Journal Of Hypertension And Cardiology 2019;2:20–7. 10.14302/issn.2329-9487.jhc-19-2714

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa