Prevalence of Hypertension and Cardiovascular Risk According to Blood Pressure Thresholds Used for Diagnosis.
Pubmed ID: 30354757
Pubmed Central ID: PMC6205214
Journal: Hypertension (Dallas, Tex. : 1979)
Publication Date: 09/01/2018
Affiliation: Department of Epidemiology (I.H.d.B.), Kidney Research Institute, University of Washington, Seattle.
MeSH Terms: Humans, Male, Adult, Female, Aged, Cardiovascular Diseases, Risk Factors, United States, Middle Aged, Prevalence, Hypertension, Clinical Trials as Topic, Risk Assessment, Blood Pressure, Young Adult, Nutrition Surveys, Cardiovascular System
Grants: R01 DK088762, R01 HL096875
Authors: Bansal N, de Boer IH, Lamprea-Montealegre JA, Zelnick LR, Hall YN
Cite As: Lamprea-Montealegre JA, Zelnick LR, Hall YN, Bansal N, de Boer IH. Prevalence of Hypertension and Cardiovascular Risk According to Blood Pressure Thresholds Used for Diagnosis. Hypertension 2018 Sep;72(3):602-609.
- Action to Control Cardiovascular Risk in Diabetes (ACCORD)
- Systolic Blood Pressure Intervention Trial (SPRINT)
- Systolic Blood Pressure Intervention Trial Primary Outcome Paper (SPRINT-POP) Data
We sought to estimate the prevalence of hypertension and characteristics of hypertensive adults in the United States according to blood pressure (BP) thresholds used for diagnosis and estimate their associated cardiovascular disease risk. Analyses included adults 20 years of age or older in the 2013 to 2014 National Health and Nutrition Examination Survey (N=5389) and enrolled participants in SPRINT (Systolic Blood Pressure Intervention Trial; N=9361) and the ACCORD-BP trial (Action to Control Cardiovascular Risk in Diabetes-Blood Pressure; N=4733). In the National Health and Nutrition Examination Survey, prevalence estimates incorporated the probability of observing elevated BP on 2 separate occasions. Using the new BP thresholds of ≥130/80 mm Hg, ≈24 million new American adults would be diagnosed as having hypertension and 4.3 million would be recommended to start antihypertensive medications. These individuals would have a lower mean atherosclerotic cardiovascular disease risk (17%) than participants in SPRINT and ACCORD-BP (22% and 27%) and would be less likely to have prevalent cardiovascular disease (9% versus 17% and 34%). In SPRINT and ACCORD-BP, only a minority (9% and 13%) of participants were not on antihypertensive medications at baseline, and rates of incident cardiovascular disease in these participants were substantially lower compared with those on baseline BP medications. We conclude that adopting the American College of Cardiology/American Heart Association guidelines would lead to a substantial increase in the prevalence of hypertension and in the number of American adults recommended to start antihypertensive medications. These individuals would have a substantially lower cardiovascular risk than most participants previously studied in 2 large BP trials.