Key result
Applying the 130/80 mm Hg hypertension threshold increases target organ damage detection ~20% versus 140/90.
Why the study?
The 2017 ACC/AHA guidelines redefined hypertension from 140/90 to 130/80 mm Hg, prompting evaluation of the lower threshold's impact on the association of hypertension with target organ damage.
Does the 2017 ACC/AHA hypertension threshold of 130/80 mm Hg increase the detection of target organ damage compared to the 140/90 mm Hg threshold in a community-dwelling population?
Cross-Sectional (n=10,826)
Does the 2017 ACC/AHA hypertension threshold of 130/80 mm Hg increase the detection of target organ damage compared to the 140/90 mm Hg threshold in a community-dwelling population?
Adopting the 2017 ACC/AHA hypertension threshold of 130/80 mm Hg significantly increases the identification of patients with concurrent subclinical and clinical target organ damage.
May enhance TOD detection in community screening; leaves open prospective outcome validation before practice change.
Recently, the 2017 ACC/AHA released new hypertension guidelines and proposed a redefinition of hypertension from 140/90 to 130/80 mm Hg. This study assesses the impact of the lower threshold for hypertension diagnosis on the association of hypertension with target organ damage (TOD). Health checks were conducted in a community‐dwelling population in Shanghai in 2017 (N = 10 826; 43.26% mean, age 62 ± 12 years [range 29‐95 years]). Subclinical TOD indices were quantified in terms of left ventricular hypertrophy (LVH) by electrocardiogram (Sokolow‐Lyon standard), estimated glomerular filtration rate (eGFR), and presence of proteinuria. Information on clinical TOD was obtained by questionnaire. Arteriosclerotic cardiovascular disease (ASCVD) was determined by the 2013 ACC/ AHA recommended guidelines. Compared to the higher threshold (140/90 mm Hg), the lower threshold (130/80 mm Hg) was associated with variable rates of increased detection of hypertension and TOD: (a) Hypertension: incidence of hypertension, 29.5% (51.8%‐81.5%) increase in persons with hypertension if the threshold of 130/80 mm Hg is used; (b) Subclinical TOD: LVH, 20.8%; eGFR (30‐60 mL/min per 1.73 m 2 ), 23.7%; proteinuria, 23.5%; (c) Clinical TOD: chronic kidney disease (CKD) IV (eGFR＜30 mL/min per 1.73 m 2 ), 3.1%; diabetes (fasting glucose ≥7.0 mmol/L or HbA1C＞7.0%), 24.3%; stroke, 26.4%; chronic heart disease, 28.1%; acute myocardial infarction, 19.5% (69.4% to 88.9% of total of 36); ASCVD ≥10%, 29.3%. The lower threshold was associated with a significantly higher detection rate of clinical and subclinical TOD of approximately 20% compared to the higher threshold. 15%‐20% of TOD and 29% of ASCVD were also found below the lower threshold of hypertension.
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Wang et al. (2019) conducted a cross-sectional in Hypertension (n=10,826). 130/80 mm Hg hypertension threshold vs. 140/90 mm Hg hypertension threshold was evaluated on Detection of clinical and subclinical target organ damage. Applying the lower 130/80 mm Hg hypertension threshold increased the detection rate of clinical and subclinical target organ damage by approximately 20% compared to the 140/90 mm Hg threshold.
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