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Comparison and Implication of the Contemporary Blood Pressure Guidelines on Korean Population
So Mi Jemma Cho1,2, Hokyou Lee2,3, Hyeon Chang Kim4
1Department of Public Health, Yonsei University Graduate School, Seoul, Korea.
Insights
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline significantly increases prevalence and uncontrolled rates, especially in younger adults, compared to the Korean Society of Hypertension (KSH) guideline. Treatment implications differ by age group.
Area of Science:
- Cardiology
- Hypertension Management
- Public Health
Background:
- Hypertension guidelines impact diagnosis and treatment.
- Comparing the 2017 ACC/AHA and 2018 KSH guidelines is crucial for the Korean population.
Purpose of the Study:
- To compare the ACC/AHA and KSH guidelines' effects on hypertension prevalence.
- To assess impacts on antihypertensive treatment recommendations and BP control.
- To analyze guideline implications in the Korean population.
Main Methods:
- Analysis of 2007-2017 Korea National Health and Nutrition Examination Survey data.
- Inclusion of 59,767 adults aged 20+.
- Calculation of guideline-specific hypertension prevalence and treatment implications by sex and age.
Main Results:
- ACC/AHA guideline showed higher prevalence (46.3%) vs. KSH (25.9%) due to lower BP cutoff, most pronounced in young adults.
- Marginal increase (1.6%) in pharmacological treatment suggested by ACC/AHA, primarily in older adults.
- Higher underachievement of BP goals with ACC/AHA (61.7%) vs. KSH (45.6%).
Conclusions:
- The ACC/AHA guideline's lower BP threshold (130/80 mmHg) increases prevalence and uncontrolled rates, particularly in younger individuals.
- Pharmacological treatment is preferentially suggested for very old individuals under ACC/AHA.
- Adapting lower BP cutoffs for KSH requires validated, population-specific cardiovascular disease risk assessment tools.
Background And Objectives:
This study compared the potential impacts of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) and the 2018 Korean Society of Hypertension (KSH) guidelines on prevalence of hypertension, recommended antihypertensive treatment, and achievement of target blood pressure (BP) in Korean population.
Methods:
We analyzed the 2007-2017 Korea National Health and Nutrition Examination Survey data to calculate guideline-specific hypertension prevalence and treatment implications on 59,767 adults aged 20 years or older by sex and age.
Results:
The prevalence of hypertension was markedly higher 46.3% by the ACC/AHA guideline due to the lowered BP cutoff than 25.9% by the KSH guideline; the increase was most pronounced in young adults. Yet, there was only a marginal 1.6% increase in the percentage of adults suggested pharmacological approach by the ACC/AHA guideline, but selectively in the older subgroups. Overall, 45.6% of Korean adults treated for hypertension failed to meet BP goal according to the KSH guideline; the underachievement extended to 61.7% of participants according to the ACC/AHA guideline.
Conclusions:
The lowered BP threshold, 130/80 mmHg, by the 2017 ACC/AHA guideline, in conjuncture with 10-year risk calculation largely driven by age, would increase pharmacological treatment preferentially in very old individuals, while increasing prevalence and uncontrolled rate mostly in younger subgroups. Adoption of lower BP cutoff to the KSH guideline would require validated cardiovascular disease risk assessment tools accounting for risk distributions specific to Korean population.
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