New information has been published fast, and what we thought we knew about hypertension has also changed fast. One of the biggest differences between American and European hypertension guidelines is whether patients with systolic blood pressure (BP) 130/139 mmHg and diastolic BP 80/89 mmHg are considered hypertensive or not. The only place where enough patients with these levels could be found is China and, while a Chinese population is clearly different from a Latin America population, this work answered some of our questions.

The effect of considering these patients as hypertensive as per American guidelines is observed in a reduction of cardiovascular risk among young or middle-aged patients, but no benefit is observed in patients ≥60 years old.

This work included 21,441 patients over 35 years old without cardiovascular disease at baseline for this registry. The follow-up was 20 years for the entire cohort and the risk of cardiovascular disease calculated could be attributed to the new stage 1 hypertension classification.

Read also: New European Hypertension Guidelines Contrast with American Recommendations.

The risk of cardiovascular disease for patients from 35 to 59 years old with stage 1 hypertension almost doubled the risk for people with BP <120/80 (hazard ratio [HR] for cardiovascular disease: 1.78; 95% confidence interval [CI]: 1.50 to 2.11). The increase in the specific risk of coronary disease was similar (HR: 1.77; 95% CI: 1.33 to 2.36), while the increase in the risk of stroke was somewhat higher (HR: 1.79; 95% CI: 1.45 to 2.22). The increase in the rate of cardiovascular death was more than double (HR: 2.50; 95% CI: 1.66 to 3.77), which is worrisome.

The proportions of cardiovascular death and events attributable to stage 1 hypertension among participants aged 35 to 59 years were 26.5% and 13.4%, respectively.

However, among participants aged ≥60 years, no higher risk was observed in patients with stage 1 hypertension compared with those with BP <120/80 mmHg.

Read also: New High Blood Pressure Guidelines.

Over 15 years, 65% of young patients with stage 1 hypertension evolved to 140/90 mmHg or higher, and their risk rates tripled compared with the remaining 35% who maintained a BP lower than 130/80 mmHg.

Conclusion

The effect of considering patients with BP between 130/139 and 80/89 mmHg (American College of Cardiology/American Heart Association [ACC/AHA] stage 1 hypertension) as hypertensive is observed only in young and middle-aged patients, while those aged ≥60 years did not evidence any association between these figures and cardiovascular risk.

Original title: Long-Term Cardiovascular Risk Associated with Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline.

Reference: Yue Qi et al. J Am Coll Cardiol 2018;72:1201-10.

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