Hypertension guidelines and coronary artery calcification among South Asians: Results from MASALA and MESA

Area of Science:

• Cardiology
• Public Health
• Genetics

Background:

• Untreated hypertension is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD), particularly in South Asian (SA) populations.
• Discrepancies in hypertension prevalence and treatment recommendations exist across different racial and ethnic groups.
• The ACC/AHA and JNC7 guidelines offer differing recommendations for antihypertensive pharmacotherapy.

Purpose of the Study:

• To assess hypertension prevalence and compare treatment recommendations between the 2017 ACC/AHA and JNC7 guidelines in untreated South Asian adults.
• To evaluate discordant treatment recommendations across various race/ethnic groups based on coronary artery calcium (CAC) scores.
• To determine if CAC scores can better inform hypertension management in American South Asians.

Main Methods:

• Analysis of untreated adults free of baseline ASCVD from the MASALA and MESA studies.
• Comparison of hypertension prevalence, demographic factors, and cardiovascular risk markers between South Asian and other racial/ethnic groups.
• Calculation of discordant antihypertensive pharmacotherapy recommendations based on ACC/AHA and JNC7 guidelines across CAC score categories.

Main Results:

• Untreated South Asians were younger, had higher diastolic blood pressure, total cholesterol, and CAC=0 prevalence compared to MESA participants.
• A higher proportion of participants received hypertension diagnoses and treatment recommendations under the ACC/AHA guideline versus JNC7.
• Discordant treatment recommendations increased with higher CAC scores across all groups, being highest among South Asians (40%).

Conclusions:

• The ACC/AHA guideline identifies more individuals needing antihypertensive pharmacotherapy compared to JNC7, particularly in South Asian populations.
• Coronary artery calcium scores may enhance the identification of South Asians who could benefit from hypertension management.
• Tailoring hypertension treatment guidelines based on CAC scores could improve cardiovascular disease risk stratification and management in diverse populations.