With 130/80 HTN Cutoff, Lifetime Risk Exceeds 80 Pct for Black Women and Men, White Men

By Marilynn Larkin

April 08, 2019

NEW YORK (Reuters Health) - Lifetime risks for hypertension are high for black men and women and white men under the American Heart Association/American College of Cardiology (AHA/ACC) 2017 guidelines, which reduced the diagnostic threshold for the disorder, researchers say.

In 2017, the AHA/ACC lowered the diagnostic threshold for hypertension from the Seventh Joint National Commission (JNC7) threshold of 140/90 mm Hg or more to 130/80 mm Hg or more.

"The lower blood pressure threshold will hopefully increase public awareness of elevated blood pressure and reduce the cumulative damage to organs than can occur in individuals with elevated blood pressure across the life course," Dr. John Wilkins of Northwestern University Feinberg School of Medicine in Chicago told Reuters Health.

"We know that individuals who never develop hypertension tend to have better outcomes than (those who do) and who are treated with medications," he said by email. "Therefore, it's best to never develop hypertension in the first place."

"We were interested in understanding how and when the risk for developing HTN develops across early adult life," he said. "Interestingly, at age 20 to 25 years old, 30% of white men, 23% of black men, and 10%-12% of women already had blood pressure values of 130/80 mm Hg or more. Thus, efforts to reduce the risks for developing hypertension, like optimization of body weight, low-sodium diets rich in fruits and vegetables, and regular physical activity should include pediatric populations, adolescents, and young adults."

"Similarly, screening to identify individuals with elevated blood pressure should begin in early life as well," he added. "Young adults who think they are otherwise healthy should definitely know their blood pressure and understand that elevated blood pressure at age 20-25 should be addressed with lifestyle modification and even medications in some individuals."

Dr. Wilkins and colleagues analyzed data from more than 13,000 US adults, ages 20-85, who were participating in studies that included multiple blood pressure assessments. Individual-level data were available for 6,314 participants at baseline. The main outcome was cumulative lifetime risk for hypertension, adjusted for competing risk of death and baseline hypertension prevalence.

As reported online March 27 in JAMA Cardiology and noted by Dr. Wilkins, for participants ages 20-30, baseline prevalence of hypertension under the AHA/ACC 2017 threshold was 30.7% in white men, 23.1% in African American men, 10.2% in white women, and 12.3% in African American women.

White men had a lifetime risk of hypertension of 83.8%; African American men, 86.1%; white women, 69.3%; and African American women, 85.7%. These risks are greater than the corresponding lifetime risks under the JNC7 threshold for hypertension (white men, 60.5%; African American men, 74.7%; white women, 53.9%, and African American women, 77.3%).

"Understanding the sex, race, and age groups that are at risk for hypertension may help public health officials and physicians identify groups and patients who may benefit most from hypertension prevention efforts and screening for elevated blood pressure," Dr. Wilkins said.

Dr. Ehete Bahiru, a cardiology fellow at the David Geffen School of Medicine at the University of California, Los Angeles, commented in an email to Reuters Health, "The lifetime hypertension risk difference between white men and African American men is noted to be only 2.3% using the lower hypertension threshold compared to the 14% risk difference based on the older guidelines," she said, adding that the findings "are consistent with prior studies that have shown African Americans are disproportionately affected by hypertension and its complications."

"The diminution of lifetime hypertension risk difference most notably between African American men and white men using the lower hypertension threshold could be a combination of several factors, including white men having higher prevalence of blood pressure in this range compared to African American men," she noted. Those white men "likely were excluded in prior risk estimates that used a threshold of 140/90."

"Secondly, age is significant risk factor for hypertension and with age, racial differences in incident hypertension likely attenuate," said Dr. Bahiru, who was not involved in the study.

Like Dr. Wilkins, Dr. Bahiru concluded, "Effective lowering of lifetime risk of hypertension involves timely screening for hypertension, lifestyle modification including prudent diet and exercise, and appropriate initiation and maintenance of antihypertensive therapy per the current recommendations."

SOURCE: http://bit.ly/2UthSI2

JAMA Cardiol 2019.