Key result
Hypertension, defined by JNC-7 guidelines, was associated with a significantly increased risk of 10-year all-cause mortality compared to normal blood pressure (HR 3.45).
Why the study?
The long-term impact of elevated blood pressure on mortality was revisited following proposed guideline cut-off changes, motivating an assessment of high blood pressure and 10-year mortality under JNC-7 versus ACC/AHA 2017 definitions.
Does elevated blood pressure according to JNC-7 and ACC/AHA 2017 guidelines increase 10-year all-cause mortality in Peruvian adults?
Cohort (n=976)
Yes
Does elevated blood pressure according to JNC-7 and ACC/AHA 2017 guidelines increase 10-year all-cause mortality in Peruvian adults?
Both JNC-7 and ACC/AHA 2017 hypertension definitions identify individuals at significantly increased risk of 10-year all-cause mortality, though the ACC/AHA 2017 criteria double the prevalence of hypertension.
High BP links to 10-year mortality across classifications; leaves open optimal thresholds for risk stratification.
<ns3:p> <ns3:bold>Background</ns3:bold> </ns3:p> <ns3:p>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.</ns3:p> <ns3:p> <ns3:bold>Methods</ns3:bold> </ns3:p> <ns3:p>Data 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.</ns3:p> <ns3:p> <ns3:bold>Results</ns3:bold> </ns3:p> <ns3:p>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-fold and 3.5-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage 1 and stage 2 hypertension.</ns3:p> <ns3:p> <ns3:bold>Conclusions</ns3:bold> </ns3:p> <ns3:p>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.</ns3:p>
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Hidalgo-Benites et al. (2023) conducted a cohort in Hypertension (n=976). Hypertension (JNC-7 definition) vs. Normal blood pressure was evaluated on 10-year all-cause mortality (HR 3.45, 95% CI 1.62-7.33, p=<0.05). Hypertension, defined by JNC-7 guidelines, was associated with a significantly increased risk of 10-year all-cause mortality compared to normal blood pressure (HR 3.45).
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