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Abstract: TH-PO684

The Impact of Change of Blood Pressure Stage According to the 2017 ACC/AHA Guideline on Cardiovascular Events Among Untreated Low-Risk Populations: A Nationwide Population-Based Cohort Study

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Kong, Kyoung Hye, Ewha Womans University, Seoul, Korea (the Republic of)
  • Oh, Hyung Jung, Ewah Womans' University, Mokdong Hospital, Seoul, Korea (the Republic of)
  • Ryu, Dong-Ryeol, Ewha Womans University, Seoul, Korea (the Republic of)
Background

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension (HTN) guideline defined new HTN thresholds. However, the evidence was largely based on studies conducted with a single baseline blood pressure (BP) measurement. Therefore, we investigated the impact of the change of BP stage according to 2017 ACC/AHA guideline on cardiovascular events (CVEs), with baseline and mean BP measurements during the follow-up of untreated, low-risk populations.

Methods

This retrospective, longitudinal study was conducted with 322,562 subjects aged ≥ 40 years without diabetes mellitus, chronic kidney disease, or previous CVE, enrolled in the Korean National Health Service-National Health Screening Cohort between 2002 and 2003, who had not taken antihypertensive medication during follow-up period. Subjects were categorized according to the 2017 ACC/AHA HTN guideline based on their baseline and mean BP during follow-up. The primary outcome of the study was newly developed CVEs (cardiovascular disease and mortality).

Results

During the median follow-up of 10 years, 2.51 events per 1,000 person-years occurred. Compared to normal (BP<120/80 mmHg) individuals, significantly increased risk of CVE was observed in individuals with stage 1 HTN (systolic BP 130-139/diastolic BP 80-89 mmHg), with both baseline and mean BP examinations. However, the hazard ratios for the CVEs using mean BP were higher those in using baseline BP. When subjects were categorized into 16 groups according to BP stages (and baseline versus mean BP measurements), the risk of CVD incidence was significantly lower when BP stage calculated using the mean BP decreased compared to the reference (the BP stage remained same between the baseline BP and mean BP) in the population with stage 1 and 2 HTN.

Conclusion

Stage 1 and 2 HTN, defined by the 2017 ACC/AHA guideline, were significantly associated with an increase of CVEs in the analysis with baseline and mean BP measurements among untreated, low-risk individuals. However, the mean BP was superior to the baseline BP for predicting CVEs. Moreover, the study suggests that physicians need to lower BP stage to prevent the occurrence of CVD when their patients, even those at low risk for CVEs, are in the stage 1 or 2 HTN groups at baseline.