Key result
Applying the 2017 ACC/AHA guideline criteria resulted in a significantly steeper secular trend of increasing hypertension prevalence compared to the 2018 Chinese guideline (β = 1.00% vs 0.67% per year).
Why the study?
To assess the impact of the 2017 ACC/AHA guideline and the 2018 Chinese hypertension guidelines on different secular trends for hypertension prevalence.
Does the application of the 2017 ACC/AHA guidelines increase the estimated prevalence and secular trend of hypertension compared to the 2018 Chinese guidelines in Chinese adults?
Cross-Sectional (n=82,665)
Yes
Does the application of the 2017 ACC/AHA guidelines increase the estimated prevalence and secular trend of hypertension compared to the 2018 Chinese guidelines in Chinese adults?
Effect estimate: β = 1.00% vs β = 0.67% per year
Absolute Event Rate: 1% vs 0.67%
p-value: p=0.041
Applying the 2017 ACC/AHA guidelines to the Chinese population results in a substantially higher and more steeply increasing prevalence of hypertension compared to the 2018 Chinese guidelines, highlighting the potential public health impact of adopting lower blood pressure thresholds.
Lower thresholds may exaggerate hypertension burden trends in China; leaves open optimal guideline selection pending outcome studies.
This study aimed to assess the impact of the 2017 American College of Cardiology and American Heart Association (ACC/AHA) guideline and the 2018 Chinese hypertension guidelines on the different secular trends for hypertension prevalence. A total of 82 665 eligible individuals aged ≥20 years were selected from nine cross‐sectional study periods (1991‐2015) from the China Health and Nutrition Survey (CHNS). Over the 24‐year period, the long‐term trend for the prevalence of the 2017 ACC/AHA‐defined age‐adjusted hypertension showed an increase from 32.2% (95% confidence interval (CI): 31.0%‐33.3%) in 1991 to 60.0% (95% CI: 58.6%‐61.3%) in 2015 (Ptrend < 0.001). According to the 2018 Chinese guideline for hypertension, the weighted hypertension prevalence increased from 10.0% (95% CI: 9.4%‐10.5%) in 1991 to 28.7% (95% CI: 27.9%‐29.6%) in 2015 (Ptrend < 0.001). However, slopes of increasing prevalence of hypertension were significantly greater according to the 2017 ACC/AHA guideline than that based on Joint National Committee (JNC 7) report (β = 1.00% vs β = 0.67% per year, respectively, P = 0.041). Based on the 2017 ACC/AHA definition, the prevalence of stage 1 hypertension and elevated blood pressure significantly increase from 22.3% and 6.9% in 1991 to 31.2% and 10.1% in 2015 (all P < 0.05), respectively. The secular trend for the prevalence of hypertension according to the 2017 ACC/AHA guideline showed a greater rate of increase compared with the prevalence based on the 2018 Chinese hypertension guidelines. Public health initiatives should focus on the current status of hypertension in China because of the possible high prevalence of hypertension and concomitant vascular risks.
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Zheng et al. (2020) conducted a cross-sectional in Hypertension (n=82,665). 2017 ACC/AHA hypertension guideline criteria vs. 2018 Chinese hypertension guideline criteria was evaluated on Slope of increasing prevalence of hypertension (β = 1.00% vs β = 0.67% per year, p=0.041). Applying the 2017 ACC/AHA guideline criteria resulted in a significantly steeper secular trend of increasing hypertension prevalence compared to the 2018 Chinese guideline (β = 1.00% vs 0.67% per year).
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