scholarly journals Measuring Hypertension Progression With Transition Probabilities: Estimates From the WHO SAGE Longitudinal Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Godfred O. Boateng ◽  
Stella T. Lartey ◽  
Philip Baiden ◽  
Lei Si ◽  
Richard Berko Biritwum ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Longitudinal Study ◽  
Fruits And Vegetables ◽  
Transition Probabilities ◽  
Transition Probability ◽  
Heart Association ◽  
Sub Saharan Africa ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Stage 1

This paper assessed the transition probabilities between the stages of hypertension severity and the length of time an individual might spend at a particular disease state using the new American College of Cardiology/American Heart Association hypertension blood pressure guidelines. Data for this study were drawn from the Ghana WHO SAGE longitudinal study, with an analytical sample of 1884 across two waves. Using a multistate Markov model, we estimated a seven-year transition probability between normal/elevated blood pressure (systolic ≤ 129 mm Hg & diastolic <80 mm Hg), stage 1 (systolic 130-139 mm Hg & diastolic 80-89 mm Hg), and stage 2 (systolic ≥140mm Hg & diastolic≥90 mm Hg) hypertension and adjusted for the individual effects of anthropometric, lifestyle, and socio-demographic factors. At baseline, 22.5% had stage 1 hypertension and 52.2% had stage 2 hypertension. The estimated seven-year transition probability for the general population was 19.0% (95% CI: 16.4, 21.8) from normal/elevated blood pressure to stage 1 hypertension, 31.6% (95% CI: 27.6, 35.4%) from stage 1 hypertension to stage 2 hypertension, and 48.5% (45.6, 52.1%) for remaining at stage 2. Other factors such as being overweight, obese, female, aged 60+ years, urban residence, low education and high income were associated with an increased probability of remaining at stage 2 hypertension. However, consumption of recommended servings of fruits and vegetables per day was associated with a delay in the onset of stage 1 hypertension and a recovery to normal/elevated blood pressure. This is the first study to show estimated transition probabilities between the stages of hypertension severity across the lifespan in sub-Saharan Africa. The results are important for understanding progression through hypertension severity and can be used in simulating cost-effective models to evaluate policies and the burden of future healthcare.

scholarly journals Characteristics of US adults who would be recommended for lifestyle modification without antihypertensive medication to manage blood pressure

2020 ◽  
Author(s):  
Sandra L Jackson ◽  
Soyoun Park ◽  
Fleetwood Loustalot ◽  
Angela M Thompson-Paul ◽  
Yuling Hong ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Lifestyle Modification ◽  
Sodium Intake ◽  
Heart Association ◽  
Lifestyle Changes ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Stage 1

Abstract Background The 2017 American College of Cardiology / American Heart Association Guideline for blood pressure (BP) management newly classifies millions of Americans with elevated blood pressure or stage 1 hypertension for recommended lifestyle modification alone (without pharmacotherapy). This study characterized these adults, including their CVD risk factors, barriers to lifestyle modification, and healthcare access. Methods This cross-sectional study examined nationally representative National Health and Nutrition Examination Survey data, 2013-2016, on 10,205 US adults aged ≥18, among whom 2,081 had elevated blood pressure or stage 1 hypertension and met 2017 ACC/AHA BP Guideline criteria for lifestyle modification alone. Results An estimated 22% of US adults (52 million) would be recommended for lifestyle modification alone. Among these, 58% were men, 43% had obesity, 52% had low quality diet, 95% consumed excess sodium, 43% were physically inactive, and 8% consumed excess alcohol. Many reported attempting lifestyle changes (range: 39%-60%). Those who reported receiving health professional advice to lose weight (adjusted prevalence ratio 1.21, 95% confidence interval 1.06-1.38), reduce sodium intake (2.33, 2.00-2.72), or exercise more (1.60, 1.32-1.95) were significantly more likely to report attempting changes. However, potential barriers to lifestyle modification included 28% of adults reporting disability, asthma, or arthritis. Additionally, 20% had no health insurance and 22% had no healthcare visits in the last year. Conclusions One fifth of US adults met 2017 ACC/AHA BP Guideline criteria for lifestyle modification alone, and many reported attempting behavior change. However, barriers exist such as insurance gaps, limited access to care, and physical impairment.

scholarly journals Thoracic Aortic Calcification and Pre-Clinical Hypertension by New 2017 ACC/AHA Hypertension Guidelines

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1027
Author(s):  
Ya-Ting Jan ◽  
Pei-Shan Tsai ◽  
Chris T. Longenecker ◽  
Dao-Chen Lin ◽  
Chun-Ho Yun ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Surrogate Marker ◽  
Heart Association ◽  
Aortic Calcification ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Contributing Factors ◽  
Hypertension Guidelines ◽  
Pressure Threshold ◽  
Thoracic Aortic Calcification

The recently revised 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension (HTN) guidelines employ a lower blood pressure threshold to define HTN, aiming for earlier prevention of HTN-related cardiovascular diseases (CVD). Thoracic aortic calcification (TAC), a new surrogate marker of aging and aortic medial layer degeneration, and different stages of HTN, according to the 2017 ACC/AHA HTN guidelines, remain unknown. We classified 3022 consecutive asymptomatic individuals enrolled into four HTN categories using the revised 2017 ACC/AHA guidelines: normal blood pressure (NBP), elevated blood pressure (EBP), and stage 1 (S1) and stage 2 (S2) HTN. The coronary artery calcification score and TAC metrics (total Agaston TAC score, total plaque volume (mm3), and mean density (Hounsfield units, HU)) were measured using multi-detector computed tomography. Compared to NBP, a graded and significant increase in the TAC metrics was observed starting from EBP and S1 and S2 HTN, using the new 2017 ACC/AHA guidelines (NBP as reference; all trends: p < 0.001). These differences remained consistent after being fully adjusted. Older age (>50 years), S1 and S2 HTN, prevalent diabetes, and chronic kidney disease (<60 mL/min/1.73 m2) are all independently contributing factors to higher TAC risk using multivariate stepwise logistic regressions (all p ≤ 0.001). The optimal cutoff values of systolic blood pressure, diastolic blood pressure, and pulse pressure were 121, 74, and 45 mmHg, respectively, for the presence of TAC after excluding subjects with known CVD and ongoing HTN medication treatment. Our data showed that the presence of TAC starts at a stage of elevated blood pressure not categorized as HTN from the updated 2017 ACC/AHA hypertension guidelines.

Perinatal outcomes in women with elevated blood pressure and stage 1 hypertension

2020 ◽  
Author(s):  
Victoria R. Greenberg ◽  
Michelle Silasi ◽  
Lisbet S. Lundsberg ◽  
Jennifer F. Culhane ◽  
Uma M. Reddy ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Perinatal Outcomes ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Stage 1

scholarly journals 119: Adverse perinatal outcomes associated with elevated blood pressure and stage 1 hypertension

2020 ◽  
Vol 222 (1) ◽  
pp. S92-S93
Author(s):  
Martha Tesfalul ◽  
Jeffrey Sperling ◽  
Cinthia Blat ◽  
Nisha Parikh ◽  
Juan Gonzalez Velez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Perinatal Outcomes ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Adverse Perinatal Outcomes ◽  
Stage 1

scholarly journals 2017 ACC/AHA blood pressure classification and incident peripheral artery disease: The Atherosclerosis Risk in Communities (ARIC) Study

2019 ◽  
Vol 27 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Yifei Lu ◽  
Shoshana H Ballew ◽  
Hirofumi Tanaka ◽  
Moyses Szklo ◽  
Gerardo Heiss ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Peripheral Artery Disease ◽  
Cox Regression ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Stage 1

Aims The aim of this study was to evaluate the associations of blood pressure categorization based on the 2017 American College of Cardiology and American Heart Association guideline with the risk of peripheral artery disease (PAD). Methods Among 13,113 middle-aged participants, we investigated the associations of 2017 blood pressure categories (systolic <120 and diastolic <80 mmHg (normal if no anti-hypertensive medications; reference), 120–129 and <80 (elevated), 130–139 and/or 80–89 (stage 1 hypertension), and ≥140 and/or ≥90 (stage 2 hypertension)) with incident PAD (hospitalizations with a diagnosis or leg revascularization) using Cox regression models. Analyses were separately conducted in individuals with and without anti-hypertensive medications. Results During a median follow-up of 25.4 years, 466 incident PAD occurred (271 cases in 9858 participants without anti-hypertensive medications). In participants without anti-hypertensive medications, we observed significant hazard ratios of PAD in elevated blood pressure (1.80 (1.28–2.51)) and stage 2 hypertension (2.40 (1.72–3.34)), but not in stage 1 hypertension. Analyzing systolic and diastolic blood pressure separately, higher systolic blood pressure categories showed significant associations with incident PAD in a graded fashion whereas, for diastolic blood pressure, only ≥90 mmHg did. Generally similar patterns were seen among participants on anti-hypertensive medication, while they had higher risk of PAD than those without at each blood pressure category. Conclusions Systolic blood pressure, including the category of 130–139 mmHg, showed stronger associations with incident PAD than did diastolic blood pressure. Consequently, elevated blood pressure conferred similar or even greater risk of PAD than stage 1 hypertension, with implications on how to interpret new blood pressure categories in terms of leg vascular health.

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