scholarly journals Potential Impact of the 2017 High Blood Pressure Guideline Beyond the United States: A Case Study of the People’s Republic of China

2020 ◽  
Vol 33 (9) ◽  
pp. 846-851
Author(s):  
Andrew Barszczyk ◽  
Deye Yang ◽  
Jing Wei ◽  
Wendy Huang ◽  
Zhong-Ping Feng ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Antihypertensive Medication ◽  
Heart Association ◽  
The United States ◽  
Atherosclerotic Cardiovascular Disease ◽  
Percentage Points ◽  
Ascvd Risk ◽  
Nationally Representative ◽  
The Impact

Abstract BACKGROUND The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) (US) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults expanded the definition of hypertension and now considers atherosclerotic cardiovascular disease (ASCVD) risk in determining treatment for people with hypertension. US guidelines are influential around the world and it is therefore justified to study their impact in other settings. Our study determined the impact of adopting the 2017 ACC/AHA guideline in China. METHODS We analyzed the population impact of the 2017 ACC/AHA guideline using the 2011–2012 year of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative sample of Chinese adults 45–74 years of age (n = 11,822). Our analysis was unique because for the first time it used a population-appropriate equation to calculate ASCVD risk instead of the US Pooled Cohort Equation (the latter misrepresents risk in non-US populations). RESULTS Adopting the 2017 ACC/AHA guideline in China would increase the prevalence of hypertension from 44.1% to 56.4% (12.3 percentage points) and increase the number of adults recommended for antihypertensive medication from 41.6% to 49.1% (7.5 percentage points) in the 45–74-year age range. According to Chinese (but not US) risk calculations, the 2017 ACC/AHA guideline more selectively assigns antihypertensive medication to patients at higher risk for ASCVD. CONCLUSIONS The 2017 ACC/AHA guideline brings potential for risk reduction in China and selectively recommends medication for those who would benefit most. Realizing such benefits would ultimately depend on the acceptance, adherence, and feasibility of adopting this guideline.

Abstract P151: Primary ASCVD Risk Associated With Undiagnosed Conditions Decreased Over NHANES 1999-2014

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
David R Nelson ◽  
Jessica A Davis
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Heart Disease ◽  
High Blood Pressure ◽  
The United States ◽  
High Cholesterol ◽  
Diabetes Status ◽  
Ascvd Risk ◽  
Over Time

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is a general term for a group of diseases characterized by atherosclerosis that affect the heart and blood vessels. ASCVD is the leading cause of death in the United States contributing to at least 200,000 preventable deaths from heart disease and stroke each year. Cardiovascular disease, heart disease, and stroke mortality has declined since the year 2000, due to broader use of evidence-based therapies and changes to risk factors and lifestyle modifications, but the decline began to slow after 2011. Two main risk factors contributing to ASCVD are high blood pressure and high cholesterol. Efforts have been made to increase control of these factors at the population-level, however, only those who are diagnosed can be treated. While awareness has increased over time, there is still a significant contribution to ASCVD events from those who were undiagnosed but have high blood pressure, high cholesterol, and/or diabetes. Hypothesis: To assess how much of the total U.S. population ASCVD risk is undiagnosed from 1999-2014. Methods: The Pooled Cohort Equations assessed 10-year ASCVD risk, based on age, sex, race, total cholesterol, HDL level, systolic blood pressure, use of blood pressure medication, smoking status, and diabetes status. The undiagnosed risk of the primary risk population (age 40-79 years, without missing values for necessary cholesterol, blood pressure, and glucose measures) from 1999-2014 Continuous National Health and Nutrition Examination Survey (NHANES) was calculated based on self-report questions and clinical measures, after age, sex, race, smoking, and diagnosed risks were accounted for. Linear regression for complex survey data tested whether undiagnosed risk was changing over time. Results: Applying the ASCVD risk equation to the NHANES subset (n=8,763; weighted n=104,421,757), undiagnosed conditions were associated with 10% of the projected ASCVD events. That is, per 100,000 Americans in this subset, 7,747 ASCVD events were estimated over 10-years, and 800 were based on risk from undiagnosed diabetes, hypercholesterolemia, or hypertension. However, ASCVD risk associated with undiagnosed conditions over time decreased (p<0.001), from 1,169 per 100,000 in 1999-2000, to 642 per 100,000 in 2013-2014. Conclusions: NHANES creates a unique opportunity to quantify undiagnosed ASCVD risk in a nationally representative sample. Since 1999, a sizeable portion of the US primary ASCVD risk was based on undiagnosed conditions, however, this proportion of undiagnosed risk decreased over time.

scholarly journals Association of Hypertension According to New American College of Cardiology/American Heart Association Blood Pressure Guidelines With Incident Dementia in the ARIC Study Cohort

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Jeffrey D. Hodis ◽  
Rebecca F. Gottesman ◽  
B. Gwen Windham ◽  
David S. Knopman ◽  
Pamela L. Lutsey ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Heart Association ◽  
Joint National Committee ◽  
National Committee ◽  
Study Cohort ◽  
Stage 1 ◽  
The Impact ◽  
Seventh Report ◽  
Detection Evaluation

Background The impact of the new 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline on dementia risk at the population level has not been evaluated. Methods and Results We studied dementia‐free participants in the ARIC (Atherosclerosis Risk in Communities) Study cohort in 1987 to 1989. Hypertension was defined by 2003 Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and 2017 ACC/AHA guidelines using blood pressure measured at baseline. Dementia was defined using adjudicated consensus diagnoses, informant telephone interviews, and discharge codes from hospitalizations and death certificates. Cox regression estimated hazard ratios (HRs) for dementia and 95% CIs by hypertension categories, adjusting for confounders. Population attributable fraction of dementia was calculated by hypertension categories. Among 13 971 participants followed up for a median of 23 years, 1381 dementia cases were identified. Prevalence of hypertension was 34% and 48%, according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and ACC/AHA criteria, respectively. HRs (95% CIs) compared with normal blood pressure, according to ACC/AHA categories, were 1.35 (1.12–1.61) for elevated blood pressure, 1.28 (1.07–1.52) for hypertension stage 1, and 1.36 (1.18–1.57) for hypertension stage 2. Population attributable fractions (95% CIs) of dementia from blood pressure categories were 3% (1%–5%), 3% (1%–5%), and 9% (4%–14%), respectively. Population attributable fractions (95% CIs) using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure categories were 6% (3%–9%) for prehypertension, 0% (−2% to 2%) for hypertension stage 1, and 9% (5%–13%) for hypertension stage 2. Conclusions Risk of dementia increased across hypertension categories defined by ACC/AHA guidelines. The population impact on dementia incidence using ACC/AHA categories was similar to the impact of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

Retrospective Evaluation of ASCVD Risk and Statin Therapy Need in Nondiabetic Patients Based on the 2013 ACC/AHA Cholesterol Guidelines

2016 ◽  
Vol 30 (3) ◽  
pp. 300-305
Author(s):  
Carrie Koenigsfeld ◽  
Morgan Sayler ◽  
Hayden L. Smith ◽  
Kristin Meyer ◽  
Nicholas Lehman ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Heart Association ◽  
Patient Characteristics ◽  
Atherosclerotic Cardiovascular Disease ◽  
Medication Therapy ◽  
Lipid Panel ◽  
Group A ◽  
Ascvd Risk ◽  
Cholesterol Guidelines ◽  
The Impact

Purpose: Study goal was to assess the impact of the 2013 American College of Cardiology and the American Heart Association (ACC/AHA) Cholesterol Guidelines on patients in the fourth statin benefit group which included patients aged 40 to 75 years, without diabetes or clinical atherosclerotic cardiovascular disease (ASCVD), and have an ASCVD score ≥7.5%. These patients could benefit from treatment interventions by a pharmacist. Methods: Patients were identified from electronic health records. A sample of 3503 patients was ascertained from having a lipid panel performed within the 12 months before November 1, 2013. Patients were excluded if we were unable to calculate 10-year ASCVD risk. Results: A total of 3203 patients were included, with 2008 not on statin therapy. Of those, 1507 (75%) had a 10-year ASCVD risk score <7.5% and 501 (25%) had a score > 7.5%. Patient characteristics leading to an increase in risk included advanced age, smoker, male, and hypertension treatment. Of 2008 nonstatin patients, there were 466 (23.2%) who fit criteria for initiation of moderate- or high-intensity statin. Conclusion: Widespread adoption of the 2013 ACC/AHA Cholesterol Guidelines will expand prescribing rates of statins. Implementing screening strategies may help identify patients who require treatment in this fourth statin benefit group. A pharmacist can be vital in screening patients, educating patients regarding the need for medication therapy, and monitoring for adherence in these new regimens.

scholarly journals Debt Relief and Debtor Outcomes: Measuring the Effects of Consumer Bankruptcy Protection

2015 ◽  
Vol 105 (3) ◽  
pp. 1272-1311 ◽  
Author(s):  
Will Dobbie ◽  
Jae Song
Keyword(s):  
United States ◽  
Social Insurance ◽  
The United States ◽  
Debt Relief ◽  
Random Assignment ◽  
Percentage Points ◽  
Consumer Bankruptcy ◽  
Annual Earnings ◽  
The Impact

Consumer bankruptcy is one of the largest social insurance programs in the United States, but little is known about its impact on debtors. We use 500,000 bankruptcy filings matched to administrative tax and foreclosure data to estimate the impact of Chapter 13 bankruptcy protection on subsequent outcomes. Exploiting the random assignment of bankruptcy filings to judges, we find that Chapter 13 protection increases annual earnings by $5,562, decreases five-year mortality by 1.2 percentage points, and decreases five-year foreclo-sure rates by 19.1 percentage points. These results come primarily from the deterioration of outcomes among dismissed filers, not gains by granted filers. (JEL D14, I12, J22, J31, K35)

scholarly journals Hypertension in the United States Fire Service

2021 ◽  
Vol 18 (10) ◽  
pp. 5432
Author(s):  
Saeed U. Khaja ◽  
Kevin C. Mathias ◽  
Emilie D. Bode ◽  
Donald F. Stewart ◽  
Kepra Jack ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Population ◽  
Age Groups ◽  
Total Sample ◽  
The United States ◽  
Fire Service ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cardiac Events ◽  
Antihypertensive Medications ◽  
Increased Risk

Hypertension is a major risk factor for atherosclerotic cardiovascular disease and cardiac remodeling and is associated with an increased risk of sudden cardiac events, the leading cause of duty-related death in the fire service. We assessed systemic blood pressures and prevalence of hypertension among US firefighters by decade of life. Medical records of career firefighters (5063 males and 274 females) from four geographically diverse occupational health clinics were assessed. Hypertension was defined as systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg, or taking antihypertensive medication. Results from the firefighter sample were compared to the US general population (2015–2016 and 2017–2018 National Health and Nutrition Examination Surveys). Among the total sample, 69% of firefighters met the criteria for hypertension and 17% were taking antihypertensive medications. Percentages of hypertensive male and female firefighters were 45% and 11% among 20–29 years old, respectively, and increased to 78% and 79% among 50–59 years old, respectively. Compared to the general population, male firefighters had a higher prevalence of hypertension (p < 0.05) across all age groups (11–16% higher). In order to improve firefighter health and protect against sudden incapacitation in this public safety occupational group, increased efforts are necessary to screen for and manage high blood pressure.

Abstract 14677: Distribution of 10- and 30-year Predicted Risks for Atherosclerotic Cardiovascular Disease in the United States: NHANES 2015 to 2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nilay S Shah ◽  
Hongyan Ning ◽  
Amanda Perak ◽  
Norrina B Allen ◽  
John T Wilkins ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Life Course ◽  
Risk Model ◽  
The United States ◽  
Atherosclerotic Cardiovascular Disease ◽  
Middle Aged ◽  
Ascvd Risk ◽  
The Life Course ◽  
Predicted Risk

Introduction: Premature fatal cardiovascular disease rates have plateaued in the US. Identifying population distributions of short- and long-term predicted risk for atherosclerotic cardiovascular disease (ASCVD) can inform interventions and policy to improve cardiovascular health over the life course. Methods: Among nonpregnant participants age 30-59 years without prevalent CVD from the National Health and Nutrition Examination Surveys 2015-18, continuous 10 year (10Y) and 30 year (30Y) predicted ASCVD risk were assigned using the Pooled Cohort Equations and a 30-year competing risk model, respectively. Intermediate/high 10Y risk was defined as ≥7.5%, and high 30Y risk was chosen a priori as ≥20%, based on 2019 guideline levels for risk stratification. Participants were combined into low 10Y/low 30Y, low 10Y/high 30Y, and intermediate/high 10Y categories. We calculated and compared risk distributions overall and across race-sex, age, body mass index (BMI), and education using chi-square tests. Results: In 1495 NHANES participants age 30-59 years (representing 53,022,413 Americans), median 10Y risk was 2.3% and 30Y risk was 15.5%. Approximately 12% of individuals were already estimated to have intermediate/high 10Y risk. Of those at low 10Y risk, 30% had high 30Y predicted risk. Distributions differed significantly by sex, race, age, BMI, and education (P<0.01, Figure ). Black males more frequently had high 10Y risk compared with other race-sex groups. Older individuals, those with BMI ≥30 kg/m 2 , and with ≤high school education had a higher frequency of low 10Y/high 30Y risk. Conclusions: More than one-third of middle-aged U.S. adults have elevated short- or long-term predicted risk for ASCVD. While the majority of middle-aged US adults are at low 10Y risk, a large proportion among this subgroup are at high 30Y ASCVD risk, indicating a substantial need for enhanced clinical and population level prevention earlier in the life course.

scholarly journals American Heart Association High Blood Pressure Protocol 2017: A Literature Review

Cureus ◽  
2018 ◽  
Author(s):  
Asad Ali ◽  
Muhammad Abu Zar ◽  
Ahmad Kamal ◽  
Amber E Faquih ◽  
Chandur Bhan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Literature Review ◽  
High Blood Pressure ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association

scholarly journals Use of physical activity and cardiorespiratory fitness in identifying cardiovascular risk factors in male brazilian adolescents

2016 ◽  
Vol 18 (6) ◽  
pp. 678
Author(s):  
Lilian Messias Sampaio Brito ◽  
Luis Paulo Gomes Mascarenhas ◽  
Deise Cristiane Moser ◽  
Ana Cláudia Kapp Titski ◽  
Monica Nunes Lima Cat ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Body Mass ◽  
Cardiorespiratory Fitness ◽  
High Blood Pressure ◽  
Abdominal Obesity ◽  
Age Groups ◽  
Cross Sectional ◽  
The Impact

DOI: http://dx.doi.org/10.5007/1980-0037.2016v18n6p678 The aim of this study was to investigate the impact of physical activity (PA) and cardiorespiratory fitness (CRF) levels on the prevalence of overweight and high blood pressure levels in adolescents. In this observational, cross-sectional study, 614 boys aged 10-14 years were assessed for height, body mass, body mass index (BMI), waist circumference (WC) and blood pressure (BP). CRF was assessed using a run test (Léger Test) and subjects were then grouped according to their CRF level. PA level was assessed through a questionnaire (The Three Day Physical Activity Recall) and classified into two groups, namely > 300 minutes of PA/week and < 300 minutes of PA/week. Maturational stage was evaluated according to the development of pubic hair (self-assessment) as proposed by Tanner. We used statistical descriptive analysis, univariate and multivariate analyses in the total participants and subjects were divided by age. Fifty percent of the sample performed < 300 minutes of PA/week and 67.6% had unsatisfactory CRF levels. There was a higher prevalence of unsatisfactory CRF levels among subjects with altered BMI (overweight), WC (abdominal obesity) or BP (high blood pressure) for all age groups. PA history, however, did not show any significance. A total of 31% of participants were overweight, 24.8% had abdominal obesity and 15.4% had increased BP. Unsatisfactory CRF levels were found to be a better predictor for the diagnosis of cardiovascular diseases (CV) risk factors than PA history, regardless of age group. 

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