scholarly journals Comparison of the JNC7 and 2017 American College of Cardiology/American Heart Association Guidelines for the Management of Hypertension in Koreans: Analysis of Two Independent Nationwide Population-Based Studies

2019 ◽  
Vol 16 (24) ◽  
pp. 5134 ◽  
Author(s):  
Won-Jun Choi ◽  
Hye-Sun Lee ◽  
Jung Hwa Hong ◽  
Hyuk-Jae Chang ◽  
Ji-Won Lee
Keyword(s):  
Clinical Outcomes ◽  
National Health ◽  
American Heart Association ◽  
American Heart ◽  
Cox Regression ◽  
Heart Association ◽  
Survival Outcomes ◽  
National Committee ◽  
National Health Insurance System ◽  
Discrimination Ability

The optimal blood pressure (BP) guidelines in Asian populations have not been determined. We compared all-cause and cardiovascular mortality based on the Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. The National Health Insurance System-National Health Screening Cohort (NHIS-HEALS) and Korea National Health and Nutrition Examination Survey (KNHANES) were utilized. BPs were classified into three groups according to each guideline, and survival rates were analyzed with Kaplan-Meier curves and log-rank tests. Hazard ratios (HRs) were calculated using multivariable cox regression analyses, and the discriminatory ability for clinical outcomes was assessed by Harrell’s C-indexes. The JNC7 guidelines demonstrated a linear association between BP levels and survival outcomes. Adjusted HRs from the JNC7 guidelines differentiated the hypertension group (≥140/90) from the pre (130/80–139/89) and normal (<130 and <80) BP groups in clinical outcomes. In contrast, the 2017 ACC/AHA guidelines showed inconsistent survival outcomes according to BP classification (normal: <120 and <80, elevated: 120–129, and <80, and HTN: ≥130/80). According to Harrell’s C-indexes, the JNC7 guidelines had greater discrimination ability in survival outcomes in the NHIS-HEALS dataset. Our results suggest that the JNC7 guidelines are more appropriate than the 2017 ACC/AHA guidelines in Korean populations.

Global longitudinal strain predicts outcome in chronic heart failure across American Heart Association stages: results from the MyoVasc study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.O Troebs ◽  
A Zitz ◽  
S Schwuchow-Thonke ◽  
A Schulz ◽  
M.W Heidorn ◽  
...  
Keyword(s):  
American Heart Association ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
American Heart ◽  
Cox Regression ◽  
Global Longitudinal Strain ◽  
Heart Association ◽  
Increased Risk ◽  
Systolic And Diastolic Function

Abstract Background Global longitudinal strain (GLS) demonstrated a superior prognostic value over left ventricular ejection fraction (LVEF) in acute heart failure (HF). Its prognostic value across American Heart Association (AHA) stages of HF – especially under considering of conventional echocardiographic measures of systolic and diastolic function – has not yet been comprehensively evaluated. Purpose To evaluate the prognostic value of GLS for HF-specific outcome across AHA HF stages A to D. Methods Data from the MyoVasc-Study (n=3,289) were analysed. Comprehensive clinical phenotyping was performed during a five-hour investigation in a dedicated study centre. GLS was measured offline utilizing QLab 9.0.1 (PHILIPS, Germany) in participants presenting with sinus rhythm during echocardiography. Worsening of HF (comprising transition from asymptomatic to symptomatic HF, HF hospitalization, and cardiac death) was assessed during a structured follow-up with subsequent validation and adjudication of endpoints. AHA stages were defined according to current guidelines. Results Complete information on GLS was available in 2,400 participants of whom 2,186 categorized to AHA stage A to D were available for analysis. Overall, 434 individuals were classified as AHA stage A, 629 as stage B and 1,123 as stage C/D. Mean GLS increased across AHA stages of HF: it was lowest in stage A (−19.44±3.15%), −18.01±3.46% in stage B and highest in AHA stage C/D (−15.52±4.64%, P for trend &lt;0.0001). During a follow-up period of 3.0 [1.3/4.0] years, GLS denoted an increased risk for worsening of HF after adjustment for age and sex (hazard ratio, HRGLS [per standard deviation (SD)] 1.97 [95% confidence interval 1.73/2.23], P&lt;0.0001) in multivariable Cox regression analysis. After additional adjustment for cardiovascular risk factors, clinical profile, LVEF and E/E' ratio, GLS was the strongest echocardiographic predictor of worsening of HF (HRGLS [per SD] 1.47 [1.20/1.80], P=0.0002) in comparison to LVEF (HRLVEF [per SD] 1.23 [1.02/1.48], P=0.031) and E/E' ratio (HRE/E' [per SD] 1.12 [0.99/1.26], P=0.083). Interestingly, when stratifying for AHA stages, GLS denoted a similar increased risk for worsening of HF in individuals classified as AHA stage A/B (HRGLS [per SD] 1.63 [1.02/2.61], P=0.039) and in those classified as AHA stage C/D (HRGLS [per SD] 1.95 [1.65/2.29], P&lt;0.0001) after adjustment for age and sex. For further evaluation, Cox regression models with interaction analysis indicated no significant interaction for (i) AHA stage A/B vs C/D (P=0.83) and (ii) NYHA functional class &lt;II vs ≥II in individuals classified as AHA stage C/D (P=0.12). Conclusions GLS demonstrated a higher predictive value for worsening of HF than conventional echocardiographic measures of systolic and diastolic function. Interestingly, GLS indicated an increased risk for worsening of HF across AHA stages highlighting its potential value to advance risk prediction in chronic HF. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research (DZHK), Center for Translational Vascular Biology (CTVB) of the University Medical Center of the Johannes Gutenberg-University Mainz

Epidemiología de la hipertensión arterial en adultos mexicanos: diagnóstico, control y tendencias. Ensanut 2020

2021 ◽  
Vol 63 (6, Nov-Dic) ◽  
pp. 692-704
Author(s):  
Ismael Campos-Nonato ◽  
Lucía Hernández-Barrera ◽  
Cecilia Oviedo-Solís ◽  
Dolores Ramírez-Villalobos ◽  
Bernardo Hernández-Prado ◽  
...  
Keyword(s):  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Joint National Committee ◽  
National Committee

Objetivo. Describir la prevalencia de hipertensión arterial (HTA) en adultos mexicanos, la proporción que tiene tensión arterial (TA) controlada y la tendencia en el periodo 2018-2020. Material y métodos. Se midió la TA a 9 844 adultos en la Encuesta Nacional de Salud y Nutrición (Ensanut) 2020. Se consideró que tenían HTA o TA controlada cuando cumplían los criterios del Seventh Joint National Committee (JNC-7) o American Heart Association (AHA). Resultados. La prevalencia de HTA fue 49.4% (según JNC-7), de los cuales 70% desconocía su diagnóstico. Según la clasificación AHA, 30.2% de los adultos tenía HTA y 51.0% ignoraba su diagnóstico. Entre adultos con diagnóstico previo de HTA, 54.9% tuvo TA controlada. Entre el periodo 2018-2020 no se observaron cambios en las prevalencias. Conclusiones. Al menos un tercio de los adultos mexicanos tiene HTA y de ellos al menos la mitad no habían sido diagnosticados. Debe evaluarse la pertinencia de los actuales programas de diagnóstico de HTA porque el subdiagnóstico y mal control pueden ocasionar complicaciones y la muerte.

scholarly journals Factors associated with hypertension among adults in Nepal as per the Joint National Committee 7 and 2017 American College of Cardiology/American Heart Association hypertension guidelines: a cross-sectional analysis of the demographic and health survey 2016

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030206 ◽  
Author(s):  
Rajat Das Gupta ◽  
Sojib Bin Zaman ◽  
Kusum Wagle ◽  
Reese Crispen ◽  
Mohammad Rashidul Hashan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Household Wealth ◽  
Joint National Committee ◽  
National Committee ◽  
Wealth Status ◽  
Cross Sectional ◽  
Ecological Regions

ObjectivesThis study investigated the determinants of hypertension in Nepal according to both the Joint National Committee 7 (JNC7) and the American College of Cardiology/American Heart Association (2017 ACC/AHA) guidelines.DesignCross-sectional study.SettingThis study used data collected from the 2016 Nepal Demographic and Health Survey data.Participants13 393 weighted adults aged ≥18 years enrolled by a stratified cluster sampling strategy were included in our analysis.Primary and secondary outcome measuresThe primary outcome was hypertension, which was defined according to JNC7 (systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg) and 2017 ACC/AHA guidelines (SBP ≥130 mm Hg and/or DBP ≥80 mm Hg). Antihypertensive medication users were also classified as hypertensive. After descriptive analysis, multilevel logistic regression was applied to obtain ORs.ResultsAbout 21% (n=2827) and 44% (n=5918) of the individuals aged ≥18 years were classified as hypertensive according to the JNC7 and 2017 ACC/AHA guidelines, respectively. Following factors were found to be significantly associated with hypertension according to the 2017 ACC/AHA guideline: ≥70 years (adjusted OR (AOR) 5.2; 95% CI 4.3 to 6.2), 50–69 years (AOR 3.9; 95% CI 3.4 to 4.4) and 30–49 years (AOR 2.7; 95% CI 2.4 to 3.0) age groups, male gender (AOR 1.7; 95% CI 1.6 to 1.9), being overweight/obese (AOR 3.0; 95% CI 2.7 to 3.3), residence in provinces 4 (AOR 1.5; 95% CI 1.2 to 2.0) and 5 (AOR 1.5; 95% CI 1.2 to 1.9). No significant association was identified with household wealth status and ecological regions of residence using the 2017 ACC/AHA guideline.ConclusionsPer both guidelines, multiple factors were associated with hypertension. Public health programme aiming to prevent and control hypertension in Nepal should prioritise these factors and focus on individuals with a higher likelihood of hypertension irrespective of educational level, household wealth status and ecological regions of residence.

scholarly journals Differences in prevalence of hypertension subtypes according to the 2018 Korean Society of Hypertension and 2017 American College of Cardiology/American Heart Association guidelines: The Korean National Health and Nutrition Examination Survey, 2007–2017 (KNHANES IV-VII)

2019 ◽  
Vol 25 (1) ◽  
Author(s):  
So Mi Jemma Cho ◽  
Hokyou Lee ◽  
Hyeon Chang Kim
Keyword(s):  
National Health ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Nutrition Examination Survey ◽  
Cardiovascular Risks ◽  
Antihypertensive Medications ◽  
Korean Society ◽  
Health And Nutrition ◽  
Diastolic Hypertension

Abstract Background The significance of high systolic and diastolic blood pressure remains controversial. We assessed the differences in prevalence of hypertension and its subtypes according to the different hypertension diagnostic criteria embodied by the 2017 American College of Cardiology/American Heart Association (2017 ACC/AHA) and 2018 Korean Society of Hypertension (2018 KSH) guidelines. Methods We used the 2007–2017 Korea National Health and Nutrition Examination Survey (KNHANES) data to calculate guideline-specific hypertension prevalence among untreated, adult participants. By the 2017 ACC/AHA guideline, a mean SBP ≥130 mmHg, DBP ≥80 mmHg, or currently using antihypertensive medications were considered to have hypertension. Isolated diastolic hypertension (IDH) was defined as DBP ≥80 mmHg and SBP <130 mmHg, isolated systolic hypertension (ISH) as SBP ≥130 mmHg and DBP <80 mmHg, and systolic diastolic hypertension (SDH) as SBP ≥130 mmHg and DBP ≥80 mmHg. In a similar manner, by the 2018 KSH guideline, all hypertension and its subtype prevalence were calculated using the 140/90 mmHg cutoff. The two versions of all hypertension and its corresponding subtype prevalence were calculated among all study participants and separately by sex and age then compared via analysis of variance. Results The prevalence of all hypertension increased from 25.9% (95% confidence interval (CI) 25.4–26.5) defined by the 2018 KSH guideline to 46.3% (95% CI 45.6–46.9) classified by the 2017 ACC/AHA guideline. Such increase was primarily manifested through substantial increase in IDH prevalence, from 5.2% (95% CI 4.9–5.4) defined by the 2018 KSH guideline to 17.9% (95% CI 17.4–18.3) defined by the 2017 ACC/AHA guideline, and was most notably observed in young age groups, 30-49 years. ISH prevalence showed minimal differences. SDH prevalence moderately increased from 3.5% (95% CI 3.3–3.7) defined by the 2018 KSH guideline to 11.1% (95% CI 10.7–11.4) defined by the 2017 ACC/AHA guideline, achieved primarily among participants aged 50 years or above. Conclusions Changes in each subtype prevalence made differential contribution to additionally classified hypertension cases by the 2017 ACC/AHA guideline. Future studies should investigate the diastolic-associated cardiovascular risks and benefits of its long-term primary prevention in the young population.

Surrogatmarker der Insulinresistenz bei Studienteilnehmern mit metabolischem Syndrom – Daten der Berliner Altersstudie II

2016 ◽  
Vol 40 (2) ◽  
Author(s):  
Nikolaus Buchmann ◽  
Kristina Norman ◽  
Ilja Demuth ◽  
Elisabeth Steinhagen-Thiessen
Keyword(s):  
National Health ◽  
Körperliche Aktivität ◽  
American Heart Association ◽  
Metabolisches Syndrom ◽  
American Heart ◽  
Heart Association ◽  
Sensitivität Und Spezifität ◽  
Prädiktiver Wert ◽  
Blood Institute ◽  
Positiv Prädiktiver Wert

ZusammenfassungAls metabolisches Syndrom (MetS) wird ein Symptomkomplex metabolischer Veränderungen bezeichnet, der eng mit Insulinresistenz (IR) assoziiert ist. Cutoff Werte für HOMA-IR, einem Surrogatparameter für IR, zur Identifikation von Probanden mit MetS sind nicht etabliert.Insgesamt lagen Querschnittsdaten von 446 Studienteilnehmern im jüngeren Lebensalter (53% Frauen, 28±3 Jahre alt) und 1271 im höheren Lebensalter (52% Frauen, 68±4 Jahre alt) ohne Diabetes vor. MetS wurde nach den IDF/AHA/NHLBI (International Diabetes Foundation/American Heart Association/National Health, Lung and Blood Institute) Kriterien von 2009 definiert. Mittels ROC-Analyse wurden Cutoff-Werte für HOMA-IR berechnet, oberhalb derer Probanden mit MetS mit höchster Sensitivität und Spezifität erkannt werden konnten. Zuletzt wurden binär logistische Regressionsmodelle berechnet.Die Prävalenz von MetS betrug 6,7% bei den jungen und 28,3% bei den älteren Probanden. Cutoff-Werte für HOMA-IR, oberhalb derer MetS identifiziert werden konnte, waren HOMA-IR >1,88 (bei jungen Studienteilnehmern; Sensitivität 80%, Spezifität 85,3%, positiv prädiktiver Wert 80%, negativ prädiktiver Wert 15%) und HOMA-IR >1,98 (bei den älteren Studienteilnehmern; Sensitivität 73,6%, Spezifität 72,9%, positiv prädiktiver Wert 74%, negativ prädiktiver Wert 27%). Patienten oberhalb dieser Cutoff-Werte hatten im höchst adjustierten (Alter, BMI, Geschlecht, körperliche Aktivität und getrennt nach Altersgruppen) binären Regressionsmodell Odds von 5,7 (95% CI: 4,1–7,9) bei älteren und 22,2 (95% CI: 7,0–70,5) bei jüngeren Studienteilnehmern, MetS aufzuweisen.Cutoff-Werte für HOMA-IR sind im Klinikalltag nicht etabliert, könnten aber herangezogen werden, um Personen mit MetS zu identifizieren und gegebenenfalls frühzeitig eine Therapie einzuleiten, auch wenn aufgrund der negativen prädiktiven Werte eine Diagnostik des MetS durch HOMA-IR allein nicht erfolgen kann.

scholarly journals Isolated Diastolic Hypertension in the IDACO Study: An Age-Stratified Analysis Using 24-Hour Ambulatory Blood Pressure Measurements

Hypertension ◽  
2021 ◽  
Author(s):  
John W. McEvoy ◽  
Wen-Yi Yang ◽  
Lutgarde Thijs ◽  
Zhen-Yu Zhang ◽  
Jesus D. Melgarejo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Ambulatory Blood Pressure ◽  
Cardiovascular Events ◽  
American Heart Association ◽  
American Heart ◽  
Cox Regression ◽  
Heart Association ◽  
Hazard Ratio ◽  
Diastolic Hypertension

The prognostic implications of isolated diastolic hypertension (IDH), as defined by 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines, have not been tested using ambulatory blood pressure (BP) monitor thresholds (ie, 24-hour mean systolic BP <125 mm Hg and diastolic BP ≥75 mm Hg). We analyzed data from 11 135 participants in the IDACO (International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes). Using 24-hour mean ambulatory BP monitor values, we performed Cox regression testing independent associations of IDH with death or cardiovascular events. Analyses were conducted in the cohort overall, as well as after age stratification (<50 years versus ≥50 years). The median age at baseline was 54.7 years and 49% were female. Over a median follow-up of 13.8 years, 2836 participants died, and 2049 experienced a cardiovascular event. Overall, irrespective of age, IDH on 24-hour ambulatory BP monitor defined by 2017 American College of Cardiology/American Heart Association criteria was not significantly associated with death (hazard ratio, 0.95 [95% CI, 0.79–1.13]) or cardiovascular events (hazard ratio, 1.14 [95% CI, 0.94–1.40]), compared with normotension. However, among the subgroup <50 years old, IDH was associated with excess risk for cardiovascular events (2.87 [95% CI, 1.72–4.80]), with evidence for effect modification based on age ( P interaction <0.001). In conclusion, using ambulatory BP monitor data, this study suggests that IDH defined by 2017 American College of Cardiology/American Heart Association criteria is not a risk factor for cardiovascular disease in adults aged 50 years or older but is a risk factor among younger adults. Thus, age is an important consideration in the clinical management of adults with IDH.

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