Trends difference in prevalence of hypertension subtypes and hypertension control in US adults as defined by 2017 ACC/AHA Guideline and 2003 JNC7 Guideline

Abstract

This study sought to compare the trends difference in prevalence of hypertension subtypes and hypertension control in US adults, by 2017 ACC/AHA and 2003 JNC7 guidelines. Serial cross-sectional analysis of National Health and Nutrition Examination Survey data of U.S. adults with hypertension from 1999–2000 to 2017–2018 were included. Hypertension was defined with two guidelines and BP control among those with hypertension was determined by the two guidelines respectively. Hypertension grades, hypertension subtypes and hypertension accompanied with other diseases were also analyzed. A total of 22371 and 17411 participants meet the diagnostic criteria of 2017 ACC/AHA guideline and 2003 JNC7 guideline, respectively in the current study. Among all adults included in the analysis, the crude percentage of hypertension grades, hypertension subtypes and hypertension with other accompanying disease or risk (10-year predicted cardiovascular disease risk ≥ 10%, CVD history, diabetes, CKD) defined by the 2017 ACC/AHA guideline were all higher than those based on the 2003 JNC7 guideline. Among all adults with hypertension, the proportion of taking antihypertensive medication increased from 44.5% in 1999–2000 to 58.5% in 2017–2018 according to the 2017 ACC/AHA guideline compared with 60% in 1999–2000 to 74.5% in 2017–2018 according to the 2003 JNC7 guideline. Among all adults with hypertension accompanied with other diseases, hypertension with 10-year predicted cardiovascular disease risk ≥ 10% showed lowest proportion of taking antihypertensive medication, which increased from 54.9% in 1999–2000 to 69.7% in 2017–2018 and 65.7% in 1999–2000 to 79.2% in 2017–2018 based on the 2017 ACC/AHA guideline and the 2003 JNC7 guideline, respectively. The proportion of controlled BP based on the 2003 JNC7 guideline showed higher than those based on the 2017 ACC/AHA guideline and both of them revealed the similar trend. Compared with the 2003 JNC7 guideline, the 2017 ACC/AHA guideline result in increasing in both the proportion of hypertension, hypertension grades and hypertension subtypes among all adults with hypertension, and decreasing the proportion of hypertension accompanied with other diseases, the proportion of taking antihypertensive medication among all adults with hypertension, hypertension grades, hypertension subtypes or hypertension accompanied with other diseases, and the proportion of controlled BP among taking antihypertensive medication with hypertension and hypertension accompanied with 10-year ASCVD risk ≥ 10% and CVD history.