Characteristics of Americans with Stage 1 Hypertension According to the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline

[Speaker] Bernard M. Y. Cheung:1
[Co-author] Yue Fei:1, Man Fung Tsoi:1
1:Department of Medicine, University of Hong Kong, Hong Kong

Background: The 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline redefined hypertension to include people who have a systolic blood pressure (BP) of 130-139 mmHg or a diastolic BP of 80-89 mmHg. We sought to describe the characteristics of people that are now considered to have stage 1 hypertension.
Methods: Participants of the US National Health and Nutrition Examination Survey (NHANES) 2011-2012, 2013-2014, and 2015-2016 aged 20 or above with at least three measurements of BP and not on antihypertensive medication were included for analysis, using R statistics version 3.3.3 with statistical package "survey" version 3.32-1. Sampling weights were used for adjusting percentages. Hypertension was defined as systolic BP ≥130 mmHg or diastolic BP ≥80 mmHg or previous physician diagnosis of hypertension or the taking of antihypertensive medication. Abdominal obesity was defined as a waist circumference of ≥102 cm in men and ≥88 cm in women.
Results: Among 16,032 hypertensive participants, 2968 were untreated, of whom 1818 had stage 1 hypertension. Their characteristics are summarised in the Table. Mean BP±SE was 128.2±0.3/77.7±0.4 mmHg. 80.4% (95%CI: 75.7%-84.5%), 77.4% (70.6%-83.3%), and 80.8% (75.6%-85.4%) were adults younger than 60 years in 2011-2012, 2013-2014, 2015-2016, respectively. 57.4% (48.4%-66.0%), 63.6% (58.9%-68.1%), and 64.0% (56.1%-74.5%) had abdominal obesity. Only 2.7% (1.4%-4.6%), 3.9% (1.9%-6.9%) and 2.2% (1.4%-3.2%) had previous history of cardiovascular disease (CVD) whereas 19.8% (15.6%-24.6%), 20.8% (16.7%-25.4%) and 16.8% (12.1%-22.5%) were smokers.
Conclusion: Most people with stage 1 hypertension are under the age of 60 and have abdominal obesity. As a group, their mean BP is not very high and few had a history of CVD. This newly-defined category of hypertension includes young individuals with mild hypertension and low cardiovascular risk. Its utility lies in identifying them early for lifestyle interventions, which should include cessation of smoking and weight control.

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