The new 2017 ACC/AHA guideline for classification of hypertension: changes in prevalence of hypertension among adults in Bangladesh

Abstract

We analyzed the Bangladesh Demographic and Health Survey 2011 data to examine absolute differences in hypertension prevalence according to the hypertension definition of the "2017 American College of Cardiology/American Heart Association (2017 ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults" and "Seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7)" 2003 guidelines. Among 7839 participants ≥35 years, the JNC7 and 2017 ACC/AHA classified 25.7% (95% confidence interval (CI): 24.5-27.0%) and 48.0% (95% CI: 46.4-49.7%) people hypertensive, respectively. The JNC7 prevalence was 19.4% (95% CI: 18.0-21.0%) among males and 31.9% (95% CI: 30.1-33.6%) among females. The prevalence was 41.4% (95% CI: 39.4-43.5%) among males and 54.5% (95% CI: 52.4-56.4%) among females as per the 2017 ACC/AHA guideline. From JNC7 to 2017 ACC/AHA, the overall difference in prevalence was 22.3% (95% CI: 19.8-24.8%). Males and females had similar differences, 22.0% (95% CI: 18.3-25.7%) and 22.6% (95% CI: 19.4-26.0%), respectively. As per the 2017 ACC/AHA guideline, >50% prevalence was observed among people with body mass index ≥25 kg/m, college-level education, co-morbid diabetes, richest wealth quintile, females, age ≥55 years, urban residence, or living in Khulna, Rangpur or Dhaka divisions; the absolute difference was >20% in most categories. We found a substantial increase in the prevalence of hypertension due to change in blood pressure thresholds as per the 2017 ACC/AHA guideline. We recommend conducting more comprehensive population-based studies to estimate the recent burden of hypertension in Bangladesh. Future studies should estimate similar prevalence in other countries.

Prevalence and associated factors of pre‐hypertension and hypertension in Nepal: Analysis of the Nepal Demographic and Health Survey 2016

“…The combined prevalence of pre‐hypertension and hypertension in this study was 45.5%—this collective prevalence indicates that nearly half of the people aged ≥15 years in Nepal are above the normal blood pressure level and at a greater risk of cardiovascular diseases due to these conditions . This prevalence is similar to other developing countries as well as developed countries . We found an increased prevalence and odds of hypertension and pre‐hypertension among older persons, males, overweight people, and in some specific places of residence.…”

Association between blood pressure levels and cardiovascular deaths: a 20-year follow-up study in rural China

“…ACC/AHA Task Force on Clinical Practice Guidelines released the 2017 hypertension guideline, which defined SBP of 130–139 mm Hg or DBP of 80–89 mm Hg as stage 1 hypertension supported by the evidence from SPRINT 6 8. Based on the new criterion, the prevalence of hypertension would increase substantially in many countries 23–25. Although intensive blood pressure control was beneficial to cardiovascular events and total mortality, it was associated with an increased number of newly diagnosed patients with hypertension who may not develop CVD events in the future 23.…”

¿Qué representa cambiar el umbral diagnóstico de la hipertensión arterial? Guías ACC/AHA 2017 y su aplicación en Perú

“…Otros estudios también señalan incrementos en los estimados de prevalencia de hipertensión arterial [17][18][19][20][21][22][23] . Utilizando los criterios de la ACC/ AHA 2017, se ha descrito un incremento en prevalencia que supera ocho puntos porcentuales en Canadá 17 y Estados Unidos 18 y más de veinte puntos porcentuales en Japón 19 , Bangladesh 20 y China 21,22 .…”