Related Experiment Video
Updated: Nov 8, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Association of Blood Pressure Classification Using the 2017 American College of Cardiology/American Heart Association
Hidehiro Kaneko1,2, Yuichiro Yano3,4, Hidetaka Itoh1
1Department of Cardiovascular Medicine (H. Kaneko, H.I., H. Kiriyama, T.K., K.F., N.T., H.M., I.K.), University of Tokyo, Japan.
Insights
Stage 1 hypertension significantly increases the risk of heart failure (HF) and atrial fibrillation (AF). Managing elevated blood pressure (BP) is crucial for preventing these cardiovascular conditions.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Heart failure (HF) and atrial fibrillation (AF) prevalence is increasing globally.
- Limited research exists on the association between stage 1 hypertension and incident HF/AF according to 2017 ACC/AHA guidelines.
Purpose of the Study:
- To investigate the association between different blood pressure (BP) categories, including stage 1 hypertension, and the incidence of HF and AF.
- To calculate the population-attributable fractions for HF and AF associated with stage 1 and stage 2 hypertension.
Main Methods:
- Analysis of a nationwide health claims database (2005-2018) with over 2 million participants.
- Participants were categorized into normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension groups.
- Cox proportional hazards models and population attributable fractions were used to assess associations and potential preventability.
Main Results:
- Stage 1 hypertension was associated with a 30% increased risk of HF (HR 1.30) and a 21% increased risk of AF (HR 1.21).
- Stage 2 hypertension showed even higher risks for HF (HR 2.05) and AF (HR 1.52).
- Stage 1 and stage 2 hypertension accounted for 23.2% and 51.2% of HF cases, respectively, and 17.4% and 34.3% of AF cases, respectively.
Conclusions:
- Both stage 1 and stage 2 hypertension are linked to increased incidence of HF and AF in the general population.
- The ACC/AHA BP classification system can aid in identifying individuals at higher risk for HF and AF.
Background:
Heart failure (HF) and atrial fibrillation (AF) are growing in prevalence worldwide. Few studies have assessed to what extent stage 1 hypertension in the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines is associated with incident HF and AF.
Methods:
Analyses were conducted with a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2018 (n=2 196 437; mean age, 44.0±10.9 years; 58.4% men). No participants were taking antihypertensive medication or had a known history of cardiovascular disease. Each participant was categorized as having normal BP (systolic BP <120 mm Hg and diastolic BP <80 mm Hg; n=1 155 885), elevated BP (systolic BP 120-129 mm Hg and diastolic BP <80 mm Hg; n=337 390), stage 1 hypertension (systolic BP 130-139 mm Hg or diastolic BP 80-89 mm Hg; n=459 820), or stage 2 hypertension (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg; n=243 342). Using Cox proportional hazards models, we identified associations between BP groups and HF/AF events. We also calculated the population attributable fractions to estimate the proportion of HF and AF events that would be preventable if participants with stage 1 and stage 2 hypertension were to have normal BP.
Results:
Over a mean follow-up of 1112±854 days, 28 056 incident HF and 7774 incident AF events occurred. After multivariable adjustment, hazard ratios for HF and AF events were 1.10 (95% CI, 1.05-1.15) and 1.07 (95% CI, 0.99-1.17), respectively, for elevated BP; 1.30 (95% CI, 1.26-1.35) and 1.21 (95% CI, 1.13-1.29), respectively, for stage 1 hypertension; and 2.05 (95% CI, 1.97-2.13) and 1.52 (95% CI, 1.41-1.64), respectively, for stage 2 hypertension versus normal BP. Population attributable fractions for HF associated with stage 1 and stage 2 hypertension were 23.2% (95% CI, 20.3%-26.0%) and 51.2% (95% CI, 49.2%-53.1%), respectively. The population attributable fractions for AF associated with stage 1 and stage 2 hypertension were 17.4% (95% CI, 11.5%-22.9%) and 34.3% (95% CI, 29.1%-39.2%), respectively.
Conclusions:
Both stage 1 hypertension and stage 2 hypertension were associated with a greater incidence of HF and AF in the general population. The American College of Cardiology/American Heart Association BP classification system may help identify adults at higher risk for HF and AF events.
More Related Videos
Related Concept Videos
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:17Pathophysiology of Heart Failure
01:28Hypertension I: Introduction
01:28Factors affecting Blood pressure
Physiological Factors:
01:18Hypertension and Regulation of Blood Pressure