Stage 1 hypertension defined by the 2017 ACC/AHA guideline predicts future cardiovascular events in elderly Chinese individuals

Blood pressure categories defined by the 2017 ACC/AHA guideline and all-cause mortality: a national cohort study in China and meta-analysis

The 2017 American College of Cardiology/American Heart Association guideline recommends a lowered threshold for hypertension diagnosis. Nonetheless, the association of blood pressure (BP) groups defined by the new guideline and all-cause mortality has not been fully estimated, especially in general Chinese. Based on the China Health and Retirement Longitudinal Study (CHARLS) during 2011-2018, 12,964 participants aged 45 years or older at baseline were enrolled for a follow-up of 7 years. Cox proportional hazards models were used to examine the relationship of BP classifications with all-cause mortality, with normal BP (<120/80 mmHg) as a reference. Afterwards, eligible studies shed light in this field were searched in public databases, and meta-analysis was conducted. In CHARLS, there were 41.21% and 16.08% individuals with stage 2 hypertension and stage 1 hypertension, respectively. During the follow-up, 1293 death occurred. The redefined stage 1 (130-139/80-89 mmHg) and stage 2 hypertension (≥140/≥90 mmHg) were found to have increased risk of death in the crude model, but only stage 2 hypertension maintained statistically significance after adjustment. Furthermore, meta-analysis including CHARLS and nine other prospective studies, with a total of 290,609 participants followed up for 3,081,532 person-years, resulted in similar results (combined hazard ratio (95% confidence interval) was 1.07 (0.99-1.15) for stage 1 hypertension, and 1.39 (1.25-1.53) for stage 2 hypertension). The present study detected that individuals with stage 2 and stage 1 hypertension had increased likelihood to die from any cause, but only the former association achieved statistically significance. Further cohorts with long-term follow-up duration are warranted, especially in China.

Secular trends of hypertension prevalence based on 2017 ACC/AHA and 2018 Chinese hypertension guidelines: Results from CHNS data (1991-2015)

This study aimed to assess the impact of the 2017 American College of Cardiology and American Heart Association (ACC/AHA) guideline and the 2018 Chinese hypertension guidelines on the different secular trends for hypertension prevalence. A total of 82 665 eligible individuals aged ≥20 years were selected from nine cross-sectional study periods (1991-2015) from the China Health and Nutrition Survey (CHNS). Over the 24-year period, the long-term trend for the prevalence of the 2017 ACC/AHA-defined age-adjusted hypertension showed an increase from 32.2% (95% confidence interval (CI): 31.0%-33.3%) in 1991 to 60.0% (95% CI: 58.6%-61.3%) in 2015 (Ptrend  < 0.001). According to the 2018 Chinese guideline for hypertension, the weighted hypertension prevalence increased from 10.0% (95% CI: 9.4%-10.5%) in 1991 to 28.7% (95% CI: 27.9%-29.6%) in 2015 (Ptrend  < 0.001). However, slopes of increasing prevalence of hypertension were significantly greater according to the 2017 ACC/AHA guideline than that based on Joint National Committee (JNC 7) report (β = 1.00% vs β = 0.67% per year, respectively, P = 0.041). Based on the 2017 ACC/AHA definition, the prevalence of stage 1 hypertension and elevated blood pressure significantly increase from 22.3% and 6.9% in 1991 to 31.2% and 10.1% in 2015 (all P < 0.05), respectively. The secular trend for the prevalence of hypertension according to the 2017 ACC/AHA guideline showed a greater rate of increase compared with the prevalence based on the 2018 Chinese hypertension guidelines. Public health initiatives should focus on the current status of hypertension in China because of the possible high prevalence of hypertension and concomitant vascular risks.

Prevalence of high blood pressure under 2017 ACC/AHA guidelines: a systematic review and meta-analysis

To understand the prevalence of high blood pressure among the general adult population under the new diagnostic criteria. PubMed and Embase databases were systematically searched. Two investigators independently performed data extraction and quality assessment, and the disagreements were resolved by consensus with a third investigator. The random-effects model was performed to pool the prevalence of high blood pressure among the population. Subgroup and meta-regression analyses were performed to explore the source of heterogeneity. The study protocol has been registered with PROSPERO, number CRD42019147330. In total, 52 articles included in the meta-analysis with a total of 54 studies. An obvious increase in the prevalence of high blood pressure was identified by the application of new diagnostic criteria. The pooled prevalence of high blood pressure among the population was 53.01% (95% confidence interval 51.13-54.88%). Subgroup analysis showed that the WHO region, national, and age could significantly influence the prevalence of hypertension (P < 0.01). Meta-regression analyses revealed that study quality and sex ratio (male, %) did not contribute to the heterogeneity of the results (P > 0.05). The sensitivity analysis showed that the results were stable. With the use of new diagnostic criteria, the prevalence of high blood pressure has shown an upward trend, especially in Europe countries. Prevention and control measures should focus more on improving cardiovascular and cerebrovascular status in Europe countries. Standard electronic blood pressure monitors were recommended for use in future studies, and at least two more readings should be taken during a visit.

Stage 1 hypertension defined by the 2017 ACC/AHA guideline predicts future cardiovascular events in elderly Chinese individuals

The 2017 American College of Cardiology and American Heart Association (ACC/AHA) hypertension guideline updated stage 1 hypertension defined as systolic blood pressure (SBP) of 130‐139 mm Hg or diastolic blood pressure (DBP) of 80‐89 mm Hg. However, the impact of 1 hypertension that affects future cardiovascular risk remains unclear among older adults in rural China. The prospective cohort study included 7503 adults aged ≥60 years with complete data and no cardiovascular disease (CVD) at baseline. Follow‐up for the new adverse events was conducted from the end of the baseline survey to the end of the third follow‐up survey (2007.01‐2017.12). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for blood pressure (BP) classifications and adverse events with normal BP as reference (< 120/80 mm Hg). During the 57 290 person‐years follow‐up period, 2261 all‐cause mortality, 1271 CVD mortality, 1159 stroke, and 347 myocardial infarctions (MI) occurred. Patients with stage 1 hypertension versus normal BP had HRs (95% CI) of 1.068 (0.904‐1.261) for all‐cause mortality, 1.304 (1.015‐1.675) for CVD mortality, 1.449 (1.107‐1.899) for stroke, and 1.735 (1.051‐2.863) for MI, respectively. In conclusion, among adults aged ≥60 years, stage 1 hypertension revealed an increased hazard of CVD mortality, stroke, and MI, which is complementary evidence for the application of 2017 ACC/AHA hypertension guidelines in an older Chinese population. Therefore, BP control in patients with stage 1 hypertension may be beneficial to reduce the hazard of CVD in elderly Chinese individuals.