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Appropriateness of the 2017 ACC/AHA Guidelines: Applied to Data from the China National Stroke Screening and Prevention Project Study

24 Pages Posted: 16 Oct 2018

See all articles by Dajie Chen

Dajie Chen

Huazhong University of Science and Technology (Formerly Tongi Medical University)

Wenzhen Li

Huazhong University of Science and Technology (Formerly Tongi Medical University)

Shuai Liu

Government of the People's Republic of China - National Health and Family Planning Commission

Xiaojun Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University)

Xiaojie Chen

Wuhan University

Jiafeng Chen

Wuhan University

Jing Ma

Harvard University

Fujian Song

University of East Anglia (UEA)

Hui Li

Huazhong University of Science and Technology (Formerly Tongi Medical University)

Shijiao Yan

Hainan Medical University - School of Public Health; Hainan Medical University - Key Laboratory of Emergency and Trauma of Ministry of Education

Xiaoxu Yin

Huazhong University of Science and Technology (Formerly Tongi Medical University)

Shiyi Cao

Huazhong University of Science and Technology (Formerly Tongi Medical University) - School of Public Health

Yanhong Gong

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Social Medicine and Health Management

Junan Liu

Huazhong University of Science and Technology (Formerly Tongi Medical University)

Wei Yue

Tianjin Huanhu Hospital

Feng Yan

Capital Medical University

Longde Wang

Government of the People's Republic of China - National Health and Family Planning Commission

Chuanzhu Lv

Hainan Medical University - Department of Emergency; Hainan Medical University - Emergency and Trauma College; Hainan Medical University - Key Laboratory of Emergency and Trauma of Ministry of Education

Zhihong Wang

Shenzhen University

Zuxun Lu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - School of Public Health; Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Social Medicine and Health Management; Huazhong University of Science and Technology (Formerly Tongi Medical University) - School of Medicine and Health Management

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Abstract

Background:   In November 2017, the American College of Cardiology/American Heart Association (ACC/AHA) updated their definition of hypertension from 140/90 mm Hg to 130/80 mm Hg. We sought to assess the situation of hypertension and the appropriateness of applying the new threshold to a geographically and ethnically diverse population.  

Methods:   We analyzed selected data on 237,142 participants aged ≥40 who had blood pressure taken for the China National Stroke Screening and Prevention Project. Choropleth maps and logistic regression analyses were performed to estimate the prevalence, geographical distribution and risk factors of hypertension using both 2017 ACC/AHA guidelines and 2014 evidence based guidelines.  

Findings:   The age- and sex-standardized prevalence of hypertension was 41.20% and 73.15% respectively, according to 2014 evidence based guidelines and 2017 ACC/AHA guidelines. The distribution of hypertension and risk factors changed little between guidelines, with data showing a high prevalence of hypertension around Bohai Gulf and in south central coastal areas using either definition. The age- and sex-standardized prevalence of newly labeled as hypertensive was 31.95%. Interestingly, the high prevalence region of newly labeled as hypertensive was found in the north China.  

Interpretation:  The prevalence of hypertension increased significantly on 2017 ACC/AHA guidelines compared to the prevalence when using 2014 evidence based guidelines, with high prevalence areas of newly labeled as hypertensive now seen mainly in north China. The present study suggests the new threshold maybe more appropriate in areas with relatively low temperatures and in North America, European countries.  

Funding Statement:  The China National Stroke Prevention Project was sponsored by the Ministry of Finance of the People’s Republic of China (issued by Finance and Social Security [2011] Document No. 61, Ministry of Finance). This work was supported by: the Fundamental Research Funds for the Central Universities, Huazhong University of Science and Technology, Wuhan, China, (2016YXMS215); the Innovation Committee of Shenzhen Science and Technology, “Demonstration Application of Cardiovascular and Cerebrovascular Disease Prevention and Control Based on Functional Community” (KJYY20170413162318686).

Declaration of Interests: The authors declare "none."

Ethics Approval Statement: The study protocol was approved by ethics committee of the XuanWu Hospital Institutional Review Board, Capital Medical University (Beijing, China). Written informed consent was obtained from all study participants. The screening work was conducted by trained clinics in the participants’ residential area according to a standard protocol.

 

Keywords: hypertension burden, prevalence, geographical distribution, risk factors, 2017 AHA/ACC hypertension guidelines

Suggested Citation

Chen, Dajie and Li, Wenzhen and Liu, Shuai and Wang, Xiaojun and Chen, Xiaojie and Chen, Jiafeng and Ma, Jing and Song, Fujian and Li, Hui and Yan, Shijiao and Yin, Xiaoxu and Cao, Shiyi and Gong, Yanhong and Liu, Junan and Yue, Wei and Yan, Feng and Wang, Longde and Lv, Chuanzhu and Wang, Zhihong and Lu, Zuxun, Appropriateness of the 2017 ACC/AHA Guidelines: Applied to Data from the China National Stroke Screening and Prevention Project Study (November 10, 2018). Available at SSRN: https://ssrn.com/abstract=3265564 or http://dx.doi.org/10.2139/ssrn.3265564

Dajie Chen

Huazhong University of Science and Technology (Formerly Tongi Medical University)

1037 Luoyu Rd
Wuhan, Hubei 430074
China

Wenzhen Li

Huazhong University of Science and Technology (Formerly Tongi Medical University)

1037 Luoyu Rd
Wuhan, Hubei 430074
China

Shuai Liu

Government of the People's Republic of China - National Health and Family Planning Commission

Beijing
China

Xiaojun Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University)

1037 Luoyu Rd
Wuhan, Hubei 430074
China

Xiaojie Chen

Wuhan University

Wuhan
China

Jiafeng Chen

Wuhan University

Wuhan
China

Jing Ma

Harvard University

1875 Cambridge Street
Cambridge, MA 02138
United States

Fujian Song

University of East Anglia (UEA)

Norwich Research Park
Norwich, Norfolk NR4 7TJ
United Kingdom

Hui Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) ( email )

1037 Luoyu Rd
Wuhan, Hubei 430074
China

Shijiao Yan

Hainan Medical University - School of Public Health

China

Hainan Medical University - Key Laboratory of Emergency and Trauma of Ministry of Education

Hainan
China

Xiaoxu Yin

Huazhong University of Science and Technology (Formerly Tongi Medical University)

1037 Luoyu Rd
Wuhan, Hubei 430074
China

Shiyi Cao

Huazhong University of Science and Technology (Formerly Tongi Medical University) - School of Public Health ( email )

1037 Luoyu Rd
Wuhan
China

Yanhong Gong

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Social Medicine and Health Management

Wuhan
China

Junan Liu

Huazhong University of Science and Technology (Formerly Tongi Medical University)

1037 Luoyu Rd
Wuhan, Hubei 430074
China

Wei Yue

Tianjin Huanhu Hospital

China

Feng Yan

Capital Medical University

China

Longde Wang

Government of the People's Republic of China - National Health and Family Planning Commission

Beijing
China

Chuanzhu Lv

Hainan Medical University - Department of Emergency

China

Hainan Medical University - Emergency and Trauma College

China

Hainan Medical University - Key Laboratory of Emergency and Trauma of Ministry of Education

Hainan
China

Zhihong Wang

Shenzhen University

3688 Nanhai Road, Nanshan District
Shenzhen, Guangdong 518060
China

Zuxun Lu (Contact Author)

Huazhong University of Science and Technology (Formerly Tongi Medical University) - School of Public Health ( email )

1037 Luoyu Rd
Wuhan
China

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Social Medicine and Health Management ( email )

Wuhan
China

Huazhong University of Science and Technology (Formerly Tongi Medical University) - School of Medicine and Health Management

13 Hangkong Road
Qiaokou District
Wuhan, 430030
China

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