Isolated systolic hypertension (HR 1.35) and isolated diastolic hypertension (HR 1.22) defined by 2017 ACC/AHA guidelines were associated with higher CVD risk compared to normal blood pressure.
Cohort (n=470,625)
Yes
Does isolated systolic hypertension (ISH) or isolated diastolic hypertension (IDH) defined by the 2017 ACC/AHA guidelines increase the risk of cardiovascular disease in adults free of CVD at baseline?
Isolated systolic and diastolic hypertension defined by the lower 2017 ACC/AHA threshold (≥130/80 mm Hg) are both associated with increased cardiovascular risk, supporting the lowered diagnostic criteria.
Effect estimate: HR 1.35 (95% CI 1.24-1.46)
Abstract Background The 2017 American College of Cardiology/American Heart Association (ACC/ AHA) blood pressure (BP) guideline lowered the hypertension threshold from a systolic blood pressure/diastolic blood pressure level of ≥140/90 mm Hg to ≥130/80 mm Hg. The significance of hypertension subtype under the new definition has not been fully explored. Objective To examine the associations of isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH) by the 2017 ACC/AHA guidelines with risk of cardiovascular disease (CVD) among the UK population. Design Prospective population-based cohort study Setting UK Biobank Participants and Methods We included 470,625 participants who were free of CVD at baseline and had available data on BP measures. Of these, 13,157 CVD events were recorded (median follow-up 8.1 years), including 6,865 nonfatal myocardial infarctions (MI), 3,415 nonfatal ischemic strokes (ISs), 1,118 nonfatal hemorrhagic strokes (HSs), and 2,971 CVD deaths. Participants were categorized into 5 groups: normal BP, normal high BP, ISH, IDH and systolic and diastolic hypertension (SDH). The associations of each type of hypertension for the risk of CVD were estimated using a Cox proportional hazards regression model with adjustment for potential confounding factors. Results According to the hypertension threshold of ≥130/80 mm Hg by ACC/AHA guideline, both ISH (HR 1.35, 95% CI 1.24-1.46) and IDH (HR 1.22, 95% CI 1.11-1.36) were significantly associated with higher risk of overall CVD risk, compared with those with normal BP. ISH was predictive of most CVD risk, except for IS; while the excess CVD risk associated with IDH appeared to be driven mainly by MI. We found heterogeneity by sex and age regarding the effects of IDH on overall CVD risk, with the associations stronger in women and younger adults (age < 60 years) and null in men and older adults (age ≥60 years). Conclusions ISH and IDH by the ACC/AHA BP guideline were both associated with increased risk of CVD, highlighting the justification to lower the criteria of hypertension definition in the UK. Further research is needed to identify participants with IDH who are at especially greater risk for developing CVD.
Li et al. (Fri,) conducted a cohort in Hypertension (n=470,625). Isolated systolic hypertension (ISH) defined by 2017 ACC/AHA guidelines (≥130/<80 mm Hg) vs. Normal blood pressure (<120/<80 mm Hg) was evaluated on Composite of nonfatal myocardial infarction, nonfatal ischemic stroke, nonfatal haemorrhagic stroke, and CVD death (HR 1.35, 95% CI 1.24-1.46). Isolated systolic hypertension (HR 1.35) and isolated diastolic hypertension (HR 1.22) defined by 2017 ACC/AHA guidelines were associated with higher CVD risk compared to normal blood pressure.