Greater CVD Risk in Certain Age Groups With New Hypertension Guidelines

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Participants who maintained their blood pressure at stage 1 hypertension levels still had a 2.28-fold higher risk of developing cardiovascular disease.
Participants who maintained their blood pressure at stage 1 hypertension levels still had a 2.28-fold higher risk of developing cardiovascular disease.

Individuals aged 35 to 59 years who would be classified as having stage 1 hypertension according to the new 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure guidelines had significantly increased risk for cardiovascular incidence and mortality, according to the results of a study published in the Journal of the American College of Cardiology.

Systolic and diastolic blood pressure were measured at baseline for participants aged 35 to 64 years in the Chinese Multi-provincial Cohort Study, which recruited from 8 of the 11 Chinese provinces. Participants were then stratified by age and blood pressure according to the new ACC/AHA blood pressure treatment guidelines. Follow-up for the occurrence of cardiovascular disease (CVD) events such as stroke, coronary heart disease, and heart failure was conducted every 1 to 2 years for 20 years, and was compared between groups.

Among the 21,441 participants in the study, 25.8% had stage 1 hypertension according to the 2017 ACC/AHA hypertension guideline (130-139/80-89 mm Hg). Of those participants, there was a significantly increased risk for CVD in the age groups of 35 to 44 and 45 to 59 years, but not in those older than 60 years (hazard ratio [HR], 1.78; 95% CI, 1.50-2.11). In addition, the HR for coronary heart disease incidence was 1.77 (95% CI, 1.33-2.36), 1.79 (95% CI, 1.45-2.22) for stroke, and 2.50 (95% CI, 1.66-3.77) for CVD mortality.

In addition, for participants aged 35 to 59 years, 65% of those classified as having stage 1 hypertension according to the 2017 ACC/AHA guideline experienced an increase in blood pressure to ≥140/90 mm Hg during a 15-year period, and they had a 3.01-fold higher risk for CVD incidence compared with those who maintained blood pressure. Participants who maintained their blood pressure at stage 1 hypertension levels during that time frame still had a 2.28-fold higher risk of developing CVD.

The study authors wrote, "This 20-year prospective cohort study found that stage 1 hypertension defined by the 2017 ACC/AHA hypertension guideline was associated with a significantly increased risk of CVD compared with normal [blood pressure], and accounted for 26.5% of cardiovascular deaths and 13.4% of cardiovascular events in Chinese adults age 35 to 59 years."

They also noted the important impact of this study, adding, "This study provides important evidence on the cardiovascular risk associated with stage 1 hypertension and foundational data for future health economics studies, which are deemed essential if adoption of this new hypertension definition is to be considered in China."

Reference

Qi Y, Han X, Dong Z, et al. Long-term cardiovascular risk associated with stage 1 hypertension defined by the 2017 ACC/AHA Hypertension Guideline. J Am Coll Cardiol. 2018;72(11):1201-1210.

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