Long-Term Cardiovascular Risk Associated With Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline

Qi, Yue; Han, Xu; Zhao, Dong; Wang, Wei; Wang, Miao; Sun, Jiayi; Li, Jun; Li, Yan; Gao, Shen; Hao, Yongchen; Deng, Qiuju; Liu, Jing

doi:10.1016/j.jacc.2018.06.056

Cited by 103 publications

(107 citation statements)

References 28 publications

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“…In the Asia Pacific Cohort Studies Collaboration Study,10 the slope of the association between SBP and IHD risk seemed to be flattened in the range of baseline SBP <160 mm Hg in the elderly (aged ≥70 years), and the 95% CI of the risk associated with baseline SBP of 120–139 mm Hg and 140–159 mm Hg overlapped that of SBP <120 mm Hg. Additionally, the recent Chinese Multi-provincial Cohort Study12 exhibited no CVD (including both IHD and stroke) risk association for an SBP of 130–139 mm Hg, compared with normal BP, among the population aged ≥60 years. The results of the Hisayama Study among the Japanese elderly were similar to ours, as the risk of SBP of 130–139 mm Hg for IHD and overall CVD was not significant compared with the reference SBP (<120 mm Hg) 13.…”

Section: Discussionmentioning

confidence: 93%

“…However, limited and even conflicting reports exist in studies on elderly Asians 10–13. The recent Chinese Multi-provincial Cohort Study found that no risk elevation was associated with an SBP of 130–139 mm Hg compared with normal BP in those aged ≥60 years 12. In the current study, we aimed to clarify whether SBP shows a linear association with cause-specific CVD mortality in all age groups and to identify whether an SBP of 130–139 mm Hg elevates CVD mortality in elderly individuals without known hypertension or CVD at baseline.…”

Section: Introductionmentioning

confidence: 94%

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Age-specific associations between systolic blood pressure and cardiovascular mortality

Jung

et al. 2019

Heart

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ObjectiveWe aimed to identify the following in all age groups among individuals without known hypertension and CVD: (1) Whether a systolic blood pressure (SBP) of 130–139 mm Hg elevates cardiovascular disease (CVD) mortality. (2) Whether SBP shows a linear association with cause-specific CVD mortality.MethodsWe used the Korean National Health Insurance sample data (n=429 220). Participants were categorised into three groups by age (40–59 years, 60–69 years and 70–80 years).ResultsDuring 10.4 years of follow-up, 4319 cardiovascular deaths occurred. A positive and graded association was generally observed between SBP and overall and cause-specific CVD mortality regardless of age, except for ischaemic heart disease (IHD) mortality in those aged 70–80 years. Among those aged 70–80 years, the HRs (95% CIs) for overall CVD mortality were 1.08 (0.92–1.28), 1.14 (0.97–1.34) and 1.34 (1.14–1.58) for SBP values of 120–129 mm Hg, 130–139 mm Hg and 140–149 mm Hg, respectively, compared with SBP <120 mm Hg. For total stroke mortality, the corresponding HRs were 1.29 (1.02–1.64), 1.37 (1.09–1.72) and 1.52 (1.20–1.93), while for IHD mortality, the corresponding HRs were 0.90 (0.64–1.26), 0.86 (0.62–1.19) and 1.29 (0.93–1.78), respectively. Non-linear associations were significant for IHD.ConclusionsIn the elderly Korean population, SBPs of 130–139 mm Hg elevated total stroke mortality, but not IHD mortality, compared with normal blood pressure, and a linear association was not observed for IHD mortality in the range <140 mm Hg.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 94%

Age-specific associations between systolic blood pressure and cardiovascular mortality

Jung

et al. 2019

Heart

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“…[10][11][12][13] In a Chinese cohort study, 65.0% of participants aged 35-59 years with BP 130-139/80-89 mm Hg experienced an increase (≥140/90 mm Hg) and a 3.01-fold increased CVD risk compared with those whose BP was maintained at <130/80 mm Hg during a 15-year follow-up period. 12 Similar CVD mortality data were observed in the younger population from the Chicago Heart Association Detection Project in Industry study during a 31-year follow-up. 13 Improvements in hypertension awareness, treatment and control rates in the younger and middle-aged population are also needed.…”

Section: Epidemi Ologymentioning

confidence: 99%

Expert consensus on the management of hypertension in the young and middle‐aged Chinese population

Liu

Chen

et al. 2019

Int J Clin Pract

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Summary Background and purposeThe increased prevalence of hypertension, along with obesity, dyslipidemia, and type 2 diabetes in the young and middle‐aged population has become a major global public health issue. Although more attention has been paid to the management of hypertension and cardiovascular disease (CVD) risks in elderly patients nationally and internationally, there is currently no consensus worldwide on appropriate evaluation and treatment of hypertension in younger subjects. We developed the consensus and aimed to provide a comprehensive strategy for the management of hypertension in young and middle‐aged population. MethodsThe authors and experts of the Hypertension Group of the 10th committee of Chinese Society of Cardiology reviewed the available literature and evidence on the pathophysiological characteristics of hypertension, CVD risk assessments and antihypertensive therapies, discussed and reached an agreement on recommendations. Disccussions and recommendationsThe pathophysiological and clinical characteristics of hypertension in young and middle‐aged patients are vastly different from those observed in the elderly. In particular, the sympathetic nervous system (SNS) and the renin‐angiotensin system (RAS) are significantly activated in this population. Global CVD risk assessment should be performed as determinants of initiating anti‐hypertensive therapy. A blood pressure (BP) target of <140/90 mm Hg should be achieved first on BP‐lowering therapies, with an ultimate BP <130/80 mm Hg for most patients, if tolerated. Initiating BP‐lowering therapies with a beta‐blocker or RAS inhibitor (angiotensin‐converting enzyme inhibitor or angiotensin II receptor blocker), or in combination with calcium channel blocker or diuretic in high CVD risk patients, along with active lifestyle changes, are preferred. ConclusionsAn aggressive and comprehensive BP and CVD risk management strategy should be implemented in the young and middle‐aged hypertensive population.

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“…It is necessary to be cautious that the beneficial effects of intensive systolic BP control have not been confirmed in European and Asian populations, including the Chinese population; even in the United States, it has been suggested that intensive antihypertensive treatment in a broad population of older adults is lacking in evidence, and may result in low‐value care . A cohort study from China implied that participants aged 35‐59 years old with stage 1 hypertension defined by the 2017 guidelines were associated with higher CVD risk; however, the association was not shown among patients aged 60 years or older …”

Section: Discussionmentioning

confidence: 99%

“…China implied that participants aged 35-59 years old with stage 1 hypertension defined by the 2017 guidelines were associated with higher CVD risk; however, the association was not shown among patients aged 60 years or older. 24 In addition, the beneficial effects of intensive BP management also remain underexplored in younger populations (≤45 years). 18,25 While high BP has been shown to have significant economic consequences based on the current guidelines, 26 the high initial cost will need to be accounted for when considering the adoption of the 2017 ACC/AHA guidelines in China.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and economic impact of the 2017 ACC/AHA guidelines on hypertension in China

Wang¹,

Hao

Wang³

et al. 2019

J of Clinical Hypertension

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The 2017 guidelines on the diagnosis and treatment of high blood pressure in adults were published by the American College of Cardiology and the American Heart Association. The impact on clinical outcomes and costs needs to be estimated prior to adopting these guidelines in China. Data from a nationally representative sample in China were analyzed. The prevalence and treatment were calculated based on the criteria of the 2017 guidelines and 2018 Chinese guidelines among participants aged ≥35 years old. Direct medical costs, as well as the averted disability adjusted of life years and cost saving from cardiovascular disease events prevented by controlling hypertension, were also estimated. The prevalence and treatment rate of hypertension were 32.0% and 43.4% according to the 2018 Chinese guidelines. Based on the 2017 guidelines, another 24.5% of the adult population (estimated 168.1 million) would be classified as having hypertension; of whom, about 32.1 million would need to be pharmaceutically treated to reach the current treatment rate of 43.4%. As a result, an estimated additional 42.7 billion US dollars of the direct medical cost would be required for lifetime therapy. By preventing cardiovascular events, the new guidelines would reduce lifetime costs by 3.77 billion US dollars, while preventing 1.41 million disability adjusted of life years lost. Application of the 2017 guidelines in China will substantially increase the prevalence of hypertension and produce a large increase in therapy costs, although it would prevent cardiovascular disease events and save disability adjusted of life years.

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Long-Term Cardiovascular Risk Associated With Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline

Abstract: The effect of 2017 American College of Cardiology/American Heart Association stage 1 hypertension on cardiovascular risk is evidenced in young and middle-aged Chinese adults, but not in those age ≥60 years.

Cited by 103 publications

References 28 publications

Age-specific associations between systolic blood pressure and cardiovascular mortality

Age-specific associations between systolic blood pressure and cardiovascular mortality

Expert consensus on the management of hypertension in the young and middle‐aged Chinese population

Clinical outcomes and economic impact of the 2017 ACC/AHA guidelines on hypertension in China

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