Potential impacts of the 2017 American College of Cardiology/American Heart Association high blood pressure guideline on Chinese adults and how to address them

Jiao, Yundi; Sun, Zhaoqing; Xie, Yanxia; Zheng, Jia; Zhao, Li; Guo, Xiaofan; Dai, Yue; Zheng, Liqiang; Sun, Yingxian

doi:10.1186/s12872-020-01523-z

Cited by 6 publications

(8 citation statements)

References 16 publications

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“…Data for the study were obtained from 9 waves of the CHNS during 1991-2015, which is an ongoing open survey that collected data in 10 visits from 1989 to 2015, conducted by the Carolina Population Center and the National Institute of Nutrition and Health, and at last covered 15 states and cities (initially 9). In this study, a multistage random cluster sampling method 16 was adopted to extract research objects. For your reference, data are available at the CHNS website (https://www.…”

Section: Data Source and Participantsmentioning

confidence: 99%

Trajectories of mid-life to elderly adulthood BMI and incident hypertension: the China Health and Nutrition Survey

Zeng

Sun

2021

BMJ Open

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ObjectivesThis study is designed to identify different body mass index (BMI) trajectories of individuals aged 40–70 years and test the effect of distinct BMI trajectories on incident hypertension.DesignThe accelerated longitudinal design was used for this study.MethodsThe study drew data from the third to ninth China Health and Nutrition Surveys (CHNS), and 4697 participants were included between 1991 and 2015. As analysed, three distinct individual BMI trajectories were identified by the latent class growth mixed model (LCGMM). Then, BMI values and BMI slopes were worked out through calculation with LCGMM trajectory parameters and their primary derivatives, respectively. Later, Cox proportional hazard models were applied to examine BMI values and slopes, and find out the relationship between the said predicted data and incident hypertension for different classes.ResultsThree different trajectory classes were identified, that is, low-stable class (n=3711), sharp-increasing class (n=282) and high-stable class (n=704). Compared with the low-stable class, the adjusted HRs (95% CI) were 1.321 (1.119 to 1.559) and 1.504 (1.322 to 1.711) for the sharp-increasing class and the high-stable class, respectively. The HR (95% CI) for BMI values rose from 1.081 (1.030 to 1.135) to 1.221 (1.171 to 1.273) while the HR (95% CI) for BMI slopes dropped from 1.154 (1.100 to 1.211) to 0.983 (0.943 to 1.025). That is, the HR for BMI slopes were higher than that for BMI values for the class aged 40–47 years.ConclusionThese findings suggest that the calibrated BMI trajectories for the period from mid-life to elderly adulthood have a significant effect on the risk of incident hypertension. The period from age 40 to 47 years is critical and has positive implications for the early prevention of hypertension.

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Section: Data Source and Participantsmentioning

confidence: 99%

Trajectories of mid-life to elderly adulthood BMI and incident hypertension: the China Health and Nutrition Survey

Zeng

Sun

2021

BMJ Open

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“…We believe that this difference could be explained by the older population in our study (≥45 years), as previous evidence has indicated that IDH is commonly found in young participants (19,20). Several studies have reported the impact on the prevalence of recommended antihypertensive medication from the 2017 ACC/AHA guideline (5,8,21). In general, the increase is minimal [e.g., 1.9% for US adults (5) and 2.7% for Chinese adults (8)], although the corresponding absolute number differs markedly due to the population size of each country.…”

Section: Discussionmentioning

confidence: 72%

“…Previous studies have primarily assessed the population impact on the prevalence or number of hypertension according to the 2017 ACC/AHA guideline. As expected, these studies suggested that the new hypertension guideline will substantially increase the number of people labeled having hypertension (5)(6)(7)(8)(9)(10). However, few studies have further explored which subtypes (i.e., ISH, SDH or IDH) are primarily responsible for this increase and the impact of the 2017 ACC/AHA guidelines on antihypertension therapy treatment by these hypertension subtypes.…”

Section: Introductionmentioning

confidence: 79%

Hypertension Subtypes, Mortality Risk, and Differential Effects Between Two Hypertension Guidelines

Mai

Li²,

Chen³

et al. 2022

Front. Med.

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Aim:To examine which hypertension subtypes are primarily responsible for the difference in the hypertension prevalence and treatment recommendations, and to assess their mortality risk if 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guideline were adopted among Chinese adults.MethodsWe used the nationally representative data of China Health and Retirement Longitudinal Study (CHARLS) to estimate the differences in the prevalence of isolated systolic hypertension (ISH), systolic diastolic hypertension (SDH) and isolated diastolic hypertension (IDH) between the 2017 ACC/AHA and the 2018 China Hypertension League (CHL) guidelines. We further assessed their mortality risk using follow-up data from the China Health and Nutrition Survey (CHNS) by the Cox model.ResultsThe increase from the 2017 ACC/AHA guideline on hypertension prevalence was mostly from SDH (8.64% by CHL to 25.59% by ACC/AHA), followed by IDH (2.42 to 6.93%). However, the difference was minuscule in the proportion of people recommended for antihypertensive treatment among people with IDH (2.42 to 3.34%) or ISH (12.00 to 12.73%). Among 22,184 participants with a median follow-up of 6.14 years from CHNS, attenuated but significant associations were observed between all-cause mortality and SDH (hazard ratio 1.56; 95% CI: 1.36,1.79) and ISH (1.29; 1.03,1.61) by ACC/AHA but null association for IDH (1.15; 0.98,1.35).ConclusionAdoption of the 2017 ACC/AHA may be applicable to improve the unacceptable hypertension control rate among Chinese adults but with cautions for the drug therapy among millions of subjects with IDH.

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“…It is convenient for early diagnosis and intervention in the case of hypertension and reduces the occurrence of adverse events caused by the condition. However, hypertension is a global public health problem, and strict diagnostic criteria will also increase medical output and even cause other social problems [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

The Value of Four Anthropometric Indicators for Identifying Left Ventricular Hypertrophy in Chinese Hypertensive Patients

Cheng

Song

et al. 2022

International Journal of Hypertension

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Left ventricular hypertrophy (LVH) has been classified separately as an independent risk factor for hypertension. However, comparisons between different body size indices and left ventricular hypertrophy (LVH) in hypertensive populations have not been reported yet. In this study, we enrolled 4,639 hypertensive patients from rural China. Anthropometric indices and cardiovascular disease risk factor variables were measured and analyzed using Spearman’s correlation, logistic regression, and receiver operating characteristic (ROC) curve analyses. Patients in the highest quartile of body size indices were more likely to have left ventricular hypertrophy than those in the lowest quartile; these indices were BMI (adjusted OR: 3.55, 95% CI: 2.90; 4.35), WC (adjusted OR: 2.23, 95% CI: 1.84; 2.70), WHR (adjusted OR: 1.44, 95% CI: 1.18; 1.75), and WHtR (adjusted OR: 3.23, 95% CI: 2.62; 3.99). The areas under the ROC curves of BMI (AUC: 0.628, 95% CI: 0.612; 0.644), WHtR (AUC: 0.628, 95% CI: 0.560; 0.593), WHR (AUC: 0.530, 95% CI: 0.513; 0.547), and WC (AUC: 0.576, 95% CI: 0.513; 0.547) were all above 0.5, which indicated that the four anthropometric indicators may be associated with LVH. The four anthropometric indicators of obesity were identified as risk factors for LVH. Weight control might help reduce the risk of left ventricular hypertrophy.

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Potential impacts of the 2017 American College of Cardiology/American Heart Association high blood pressure guideline on Chinese adults and how to address them

Cited by 6 publications

References 16 publications

Trajectories of mid-life to elderly adulthood BMI and incident hypertension: the China Health and Nutrition Survey

Trajectories of mid-life to elderly adulthood BMI and incident hypertension: the China Health and Nutrition Survey

Hypertension Subtypes, Mortality Risk, and Differential Effects Between Two Hypertension Guidelines

The Value of Four Anthropometric Indicators for Identifying Left Ventricular Hypertrophy in Chinese Hypertensive Patients

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