Hypertension Defined by 2017 ACC/AHA Guideline, Ideal Cardiovascular Health Metrics, and Risk of Cardiovascular Disease: A Nationwide Prospective Cohort Study

Abstract

Summary Background The updated definition of hypertension by the American College of Cardiology (ACC) and the American Heart Association (AHA) is an important paradigm shift and has lead to extensive discussion. We aimed to examine the association between the updated blood pressure (BP) categories and the risk of cardiovascular diseases (CVDs) with potential modifications from other cardiovascular health metrics (CVHMs). Methods This prospective study included 91,204 participants ≥40 years recruited from 20 community sites across mainland China. Participants were followed up during 2010-2016 for CVD events including nonfatal myocardial infarction, stroke, heart failure, and cardiovascular death. BP categories were defined according to the 2017 ACC/AHA guideline and CVHMs included smoking, physical activity, diet, body-mass index, total cholesterol, and fasting glucose. Findings Overall, 1,985 major CVD events occurred during a mean follow-up of 3.7 years. Having more ideal CVHMs significantly reduced the risk of CVD events in both stage 1 and stage 2 hypertension. Compared with participants without hypertension, participants having ≥4 ideal CVHMs were no longer associated with an increased CVD risk in stage 1 hypertension (HR=1·04; 95% CI=0·83-1·31), but less so in stage 2 hypertension (HR=1·90, 95% CI=1·70-2·13). Such pattern of association was more evident in participants aged <60 years ( P for interaction <0·05). Interpretation Stage 1 hypertension defined by the ACC/AHA identifies individuals at increased CVD risk, which can be attenuated by achieving more preferable cardiovascular health, especially in adults aged <60 years.

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…Moreover, participants with stage 1 hypertension having ≥4 ideal CVH components did not have significantly greater CVD risk compared with all participants without hypertension (HR, 1.04 [95% CI, 0.83–1.31]). 23…”

Association of Cardiovascular Health Score Trajectory With Incident Myocardial Infarction in Hypertensive Patients

“…A nationwide prospective cohort study conducted across mainland China reported that hypertensive patients with more ideal cardiovascular health metrics have significantly reduced incidents of CVD. 15 In another prospective study with the participation of 5488 hypertensive patients, Ying et al 28 found that an increased number of ideal cardiovascular health metrics was inversely related to the risk of ischemic stroke in participants with hypertension. However, only the baseline cardiovascular health metrics was regarded as exposure of interest and the subsequent changes in cardiovascular status were ignored in their studies.…”

“…12 Plenty of evidence has proved that higher CHS was associated with a lower risk of MI in both the general population and hypertensive patients. [13][14][15] However, the past studies only stressed the association between single CHS and MI risk while the longitudinal association between changes in CHS over time and MI risk in hypertensive patients was not examined.…”

Dawning public health services dogma: An indigenous Southwest Chinese perspective in managing hypertension-with or without the “BPHS”?

“…In addition, hypertensive patients have multiple risk factors ( 27 , 40 ), and multiple cardiovascular disease risk factors will proportionately increase the risk of coronary artery, cerebrovascular, and renal disease ( 27 , 29 ). An important part of BPHS is to assist with interventions of modifiable risk factors for hypertensive patients, including salt reduction, regular physical activity, weight reduction, smoking cessation, alcohol restriction, and reduction of psychological stress, consistent with the global practice guidelines developed by ISH ( 27 ), American College of Cardiology ( 41 ) and with the support of extensive research evidence done on hypertension ( 8 , 42 – 46 ). We also found hypertensive patients in the BPHS group had lower rates of smoking and drinking.…”

“…Controlling blood pressure to a normal state reduces the risk of cardiovascular events and all-cause mortality (6)(7)(8). The trend of cardiovascular disease will be directly impacted by how hypertension is managed in primary medical and health organizations (community health centers, township health centers, and village clinics) (9).…”