Changes in the prevalence of measures associated with hypertension among Iranian adults according to classification by ACC/AHA guideline 2017

Abstract

Background: Different definitions have been proposed to categorize hypertension. We aimed to investigate the difference in prevalence of measures associated with hypertension according to the American College of Cardiology/American Heart Association (ACC/AHA) criteria versus Joint National Committee 7 (JNC7) criteria. Methods: We analyzed the data of 10,000 participants of Yazd Health Study (YaHS) aged 20-69 years. Blood pressure was measured three times with standard protocol defined by ACC/AHA. Prevalence of high blood pressure measure was compared in both definitions and absolute differences reported. Results: The prevalence of high blood pressure in our measurement was 61.0% according to ACC/AHA, and 28.9% according to JNC 7. The prevalence of self-reported hypertension was 18.6%. Age and sex standardized prevalence rates of high blood pressure measure indicates a 2.4-fold increase in the prevalence rate (30.1% absolute difference) by the ACC/AHA guideline. While the prevalence increased in all age groups, the age group of 20-29 showed the highest relative increase by 3.6 times (10.6% vs. 38.1%). High blood pressure measure among people with diabetes increased from 45.8 to 75.3% with the ACC/AHA guideline. Of the people who had no past history of diagnosed hypertension (n = 7887), 55.1 and 22.7% had high blood pressure measure by ACC/AHA and JNC-7 guidelines, respectively. From JNC7 to ACC/AHA, the overall difference in unawareness about HTN increased by 32.4%. Conclusion: Prevalence of hypertension associated measures increased over two folds by using the ACC/AHA criteria compared to JNC 7. Also, change in the criteria, reduces awareness of the disease and increases uncontrolled hypertension respectively. More research is needed to determine if the new definitions can affect management of hypertension in societies. Considering local priorities and implication of cost effective may improve implementation of new definitions for hypertension in different countries.

Prevalence, awareness, treatment, and control of hypertension based on ACC/AHA versus JNC7 guidelines in the PERSIAN cohort study

“…Although there was some heterogeneity in prevalence across study centers, the application of the ACC/AHA guideline uniformly led to increase in relative prevalence (by 63.7%) and decrease in relative awareness (37.3%), treatment (38.7%), control among hypertensive adults (63.4%), and control among treated adults (39.5%). Yet, the increase in prevalence observed in our study was still lower than previous studies in Iran, which reported a more than a twofold higher prevalence based on the ACC/AHA guideline 16 – 18 . Less than twofold increases were also observed in other countries 10 , 11 , 19 , 20 .…”

Dietary supplements consumption and its association with socioeconomic factors, obesity and main non-communicable chronic diseases in the north of Iran: the PERSIAN Guilan Cohort Study (PGCS)

“…Diabetes was defined as fasting blood glucose equal to or higher than 126 mmol/L, or was on medication for raised blood glucose, or had a history with the diagnosis of diabetes [ 31 ]. HTN was defined as systolic blood pressure (SBP) ≥130 mmHg, and /or a diastolic blood pressure (DBP) ≥80 mmHg according to the ACC/AHA guideline, a prior diagnosis of hypertension by a health professional indicating that one had high BP or used antihypertensive drugs [ 32 ]. CVD includes the history of myocardial infarction or/and stroke or/and cardiac ischemia.…”

Prevalence, Awareness, Treatment, and Control of Hypertension in the PERSIAN Cohort Study: JNC7 Versus ACC/AHA Guidelines Short Title: The Impacts of Hypertension Definition in Iran

“…Yet, the increase in prevalence observed in our study was still lower than previous studies in Iran, which reported a more than a 2-fold higher prevalence based on the ACC/AHA guideline. [16][17][18] Less than 2-fold increases were also observed in other countries. 10,11,19,20 The results of our study showed that a total of 24 312 adults who were previously classified in the category of "pre-hypertension", were shifted to stage 1 of hypertension based on the ACC/AHA 2017 guideline.…”