Cardiovascular events according to blood pressure thresholds recommended by ACC/AHA

• Published in: Blood pressure Vol. 33; no. 1; p. 2380346
• Main Authors: Joseph, Gowsini, Thanh Pham, Vi, Kragh Andersen, Per, Louis Marott, Jacob, Møgelvang, Rasmus, Biering-Sørensen, Tor, Søgaard, Peter, Nielsen, Gitte, Prescott, Eva, Boje Jensen, Gorm, Eske Bruun, Niels, Torp-Pedersen, Christian
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis Group 01.12.2024
• Subjects: ACC/AHA guidelines; Adult; Aged; Aged, 80 and over; Blood Pressure; blood pressure thresholds; Cardiovascular Diseases - physiopathology; cardiovascular outcome; Denmark - epidemiology; Female; Humans; hypertension; Hypertension - diagnosis; Hypertension - physiopathology; Male; Middle Aged; mortality; Practice Guidelines as Topic; Prospective Studies; Risk Factors; Young Adult; Denmark; mortality; cardiovascular outcome; ACC/AHA guidelines; blood pressure thresholds; hypertension
• ISSN: 0803-7051; 1651-1999; 1651-1999
• DOI: 10.1080/08037051.2024.2380346

The latest guidelines from ACC/AHA define hypertension at systolic blood pressure (SBP) 130-139 mmHg or diastolic blood pressure (DBP) 80-89 mmHg in contrast to guidelines from ESC/ESH defining hypertension at SBP ≥ 140 mmHg or DBP ≥ 90 mmHg. The aim was to determine whether the ACC/AHA definition of hypertension identifies persons at elevated risk for future cardiovascular outcome. In a Danish prospective cardiovascular study, 19,721 white men and women aged 20-98 years were examined up to five occasions between 1976 and 2015. The population was followed until December 2018. The ACC/AHA definition of the BP levels were applied: Normal: SBP <120 mmHg and DBP <80 mmHg, Elevated: SBP 120-129 mmHg and DBP <80 mmHg, Stage 1: SBP 130-139 mmHg or DBP 80-89 mmHg, Stage 2: SBP ≥140 mmHg or DBP ≥90 mmHg. Absolute 10-year risk was calculated taking repeated examinations, covariates, and competing risk into account. For all outcomes, the 10-year risk in stage 1 hypertension did not differ significantly from risk in subjects with normal BP: The 10-year risk of cardiovascular events in stage 1 hypertension was 14.1% [95% CI 13.2;15.0] and did not differ significantly from the risk in normal BP at 12.8% [95% CI 11.1;14.5] (  = 0.19). The risk was highest in stage 2 hypertension 19.4% [95% CI 18.9;20.0] and differed significantly from normal BP, elevated BP, and stage 1 hypertension (  < 0.001). The 10-year risk of cardiovascular death was 6.6% [95% CI 5.9;7.4] in stage 1 hypertension and did not differ significantly from the risk in normal BP at 5.7% [95% CI 4.1;7.3] (  = 0.33). Stage 1 hypertension as defined by the ACC/AHA guidelines has the same risk for future cardiovascular events as normal BP. In contrast, the definition of hypertension as suggested by ESC/ESH identifies patients with elevated risk of cardiovascular events.