Key result
ACC/AHA stage 1 hypertension (130-139/80-89 mmHg) was associated with a significantly increased risk of cardiovascular disease (HR 1.20) compared to normal blood pressure (<120/80 mmHg).
Why the study?
Few studies had assessed the impact of the 2017 ACC/AHA redefined stage 1 hypertension threshold on cardiovascular outcomes among the UK population.
Does ACC/AHA stage 1 hypertension increase the risk of composite cardiovascular events in adults without a history of cardiovascular disease?
Cohort (n=470,625)
Yes
Does ACC/AHA stage 1 hypertension increase the risk of composite cardiovascular events in adults without a history of cardiovascular disease?
Hazard Ratio: 1.2 (95% CI 1.1–1.3)
Adopting the 2017 ACC/AHA hypertension guideline (130/80 mmHg) in the UK would classify 75.1% of the population as hypertensive and identifies individuals at a 20% increased risk of cardiovascular events compared to those with normal blood pressure.
May inform UK risk stratification for stage 1 HTN; extends prior data but leaves treatment benefits open.
Importance The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension (HTN) guideline lowered the threshold for HTN from 140/90 mmHg to 130/80 mmHg for systolic/diastolic blood pressure (SBP/DBP), resulting in a newly defined stage 1 HTN with an SBP/DBP reading of 130–139/80–89 mmHg. Few studies have assessed the impact of the redefined HTN on cardiovascular outcomes among UK population. Objective To examine the effects of the revised ACC/AHA stage 1 HTN blood pressure parameters on the prevalence of HTN and related cardiovascular disease (CVD) risk in a large UK population. Design Adult men and women from a national cohort study in the UK. Setting The UK Biobank Study. Participants A total of 470,625 adults (mean age 56 years) with available data on blood pressure (BP) and without history of CVDs at baseline. Main outcome measures Prevalence of HTN and incident composite CVD outcomes. Methods Prospective CVD events were analysed for survival in relation to BP measures using Cox proportional hazards regression models, adjusting for potential confounders. The associations are described by hazard ratios (HRs) and 95% confidence intervals (CIs). Results By adopting the 2017 ACC/AHA HTN guideline, an additional 24.7% of the participants were classified as having ACC/AHA stage 1 HTN, which resulted in a prevalence of HTN of 75.1% at baseline. During a mean follow-up period of 8.1 years, ACC/AHA stage 1 HTN (130–139/80–89 mmHg) was associated with a significantly increased risk of CVD (HR 1.20; 95% CI 1.10–1.30) compared to the risk associated with a normal BP (<120/80 mmHg). The excess risk of CVD associated with ACC/AHA stage 1 HTN was mainly driven by myocardial infarction (HR 1.19; 95% CI 1.05-1.36) and haemorrhagic stroke (HR 1.40; 95% CI 1.08-1.81), rather than ischaemic stroke (HR 1.02; 95% CI 0.87-1.19) and CVD death (HR 1.07; 95% CI 0.90-1.26). Conclusions The adoption of the 2017 ACC/AHA guideline would lead to a dramatic increase in the prevalence of HTN in the UK Biobank cohort study. Evidence from the present national cohort study may support lowering the threshold for HTN from 140/90 mmHg to 130/80 mmHg in the UK.
No takes yet. Share an insight, caveat, or question.
Li et al. (2020) conducted a cohort in Hypertension (n=470,625). ACC/AHA stage 1 hypertension (130-139/80-89 mmHg) vs. Normal blood pressure (<120/80 mmHg) was evaluated on Incident composite cardiovascular disease outcome (nonfatal MI, nonfatal ischaemic stroke, nonfatal haemorrhagic stroke, and CVD death) (HR 1.20, 95% CI 1.10-1.30). ACC/AHA stage 1 hypertension (130-139/80-89 mmHg) was associated with a significantly increased risk of cardiovascular disease (HR 1.20) compared to normal blood pressure (<120/80 mmHg).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: