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Prevalence of ambulatory blood pressure phenotypes using the 2017 American College of Cardiology/American Heart Association blood pressure guideline thresholds

data from the Coronary Artery Risk Development in Young Adults study

Poudel, Bharata; Booth, John N. IIIa; Sakhuja, Swatia; Moran, Andrew E.b; Schwartz, Joseph E.b,c; Lloyd-Jones, Donald M.d; Lewis, Cora E.a; Shikany, James M.a; Shimbo, Daichib; Muntner, Paula

doi: 10.1097/HJH.0000000000002055
ORIGINAL PAPERS: Guidelines
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Background: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline lowered the BP thresholds for defining hypertension compared with the Seventh Report of the Joint National Committee (JNC7) guideline.

Methods: We analyzed clinic and ambulatory BP monitoring data from 717 Coronary Artery Risk Development in Young Adults study participants and compared the prevalence of clinic and out-of-clinic BP phenotypes using thresholds from the 2017 ACC/AHA and JNC7 guidelines.

Results: Among participants not taking antihypertensive medication and according to the JNC7 and 2017 ACC/AHA guidelines, 11.1 and 30.1% of participants had clinic hypertension, 37.5 and 57.9% had awake hypertension, 35.7 and 58.1% had asleep hypertension, and 35.7 and 58.6% had 24-h hypertension, respectively. According to the JNC7 and 2017 ACC/AHA guideline definitions, 1.9 and 3.2% had white-coat hypertension, 28.2 and 31.0% had masked hypertension and 9.3 and 26.9% had sustained hypertension, respectively. Among participants taking antihypertensive medication and when defined using the JNC7 and 2017 ACC/AHA guideline BP thresholds, 18.6 and 45.3% had uncontrolled clinic BP, 48.1 and 62.5% had uncontrolled awake BP, 48.1 and 70.2% had uncontrolled asleep BP and, 47.7 and 65.3% had uncontrolled 24-h BP, respectively. Using JNC7 and 2017 ACC/AHA guideline BP thresholds, the prevalence was 1.4 and 5.2% for white-coat effect, 30.9 and 22.5% for masked uncontrolled hypertension, and 17.2 and 40.0% for sustained uncontrolled BP, respectively.

Conclusion: The 2017 ACC/AHA guideline results in a substantially higher prevalence of awake, asleep, 24-h, and sustained hypertension.

aUniversity of Alabama at Birmingham, Birmingham, Alabama

bColumbia University, New York

cStony Brook University, Stony Brook, New York

dNorthwestern University, Chicago, Illinois, USA

Correspondence to Paul Muntner, PhD, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Suite 140J, Birmingham, AL 35233, USA. Tel: +1 205 975 8077; e-mail: pmuntner@uab.edu

Abbreviations: ABPM, ambulatory blood pressure monitoring; ACC/AHA, American College of Cardiology/American Heart Association; BP, blood pressure; CARDIA, Coronary Artery Risk Development in Young Adults; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; JNC7, Seventh Report of the Joint National Committee; LVMI, left ventricular mass index

Received 6 October, 2018

Revised 13 December, 2018

Accepted 3 January, 2019

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