Key result
Hypertension is linked to ~3.5-fold higher 10-year all-cause mortality compared to normal blood pressure.
Why the study?
Proposed changes in hypertension cut-offs motivated reassessing the long-term impact of elevated blood pressure on mortality using JNC-7 versus ACC/AHA 2017 definitions.
Does classification into elevated blood pressure or hypertension categories under the JNC-7 and ACC/AHA 2017 guidelines predict 10-year all-cause mortality in a Peruvian cohort of rural, rural-to-urban migrant, and urban adults?
Cohort (n=976)
Yes
Does classification into elevated blood pressure or hypertension categories under the JNC-7 and ACC/AHA 2017 guidelines predict 10-year all-cause mortality in a Peruvian cohort of rural, rural-to-urban migrant, and urban adults?
In a Peruvian cohort, applying the ACC/AHA 2017 hypertension guidelines nearly doubled the baseline prevalence of hypertension compared to JNC-7 (31.3% vs. 16.0%), while both stage 1 and stage 2 hypertension were significantly associated with increased 10-year all-cause mortality.
Background: The long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines. Methods: Data analysis of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated. Results: A total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%-18.4%) to 31.3% (95% CI 28.4%-34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty-three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4-4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2.1-fold and 5.1-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage-1 and stage-2 hypertension. Conclusions: Blood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of the health system to adequately handle a large proportion of new patients.
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Hidalgo-Benites et al. (2023) conducted a cohort in Hypertension (n=976). Hypertension (JNC-7 and ACC/AHA 2017 blood pressure categories) vs. Normal blood pressure (SBP < 120 mm Hg and DBP < 80 mm Hg without anti-hypertensive medication) was evaluated on 10-year all-cause mortality (HR 3.45, 95% CI 1.62-7.33). Hypertension increased 10-year all-cause mortality risk compared to normal blood pressure under both JNC-7 (adjusted HR 3.45, 95% CI 1.62-7.33) and ACC/AHA 2017 Stage 2 (HR 3.48) definitions.
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