Hypertension Subtypes, Mortality Risk, and Differential Effects Between Two Hypertension Guidelines

Area of Science:

• Cardiology
• Public Health
• Epidemiology

Background:

• Hypertension prevalence and control remain significant public health challenges in China.
• Existing hypertension guidelines vary, impacting diagnosis and treatment recommendations.
• The 2017 ACC/AHA guideline offers updated criteria for hypertension management.

Purpose of the Study:

• To determine which hypertension subtypes (ISH, SDH, IDH) drive prevalence differences under the 2017 ACC/AHA guideline in Chinese adults.
• To assess the mortality risk associated with these subtypes if the 2017 ACC/AHA guideline is adopted.
• To compare the 2017 ACC/AHA guideline with the 2018 China Hypertension League (CHL) guideline.

Main Methods:

• Utilized nationally representative China Health and Retirement Longitudinal Study (CHARLS) data for prevalence estimation.
• Employed Cox proportional hazards models with follow-up data from the China Health and Nutrition Survey (CHNS) for mortality risk assessment.
• Categorized hypertension into isolated systolic hypertension (ISH), systolic diastolic hypertension (SDH), and isolated diastolic hypertension (IDH).

Main Results:

• The 2017 ACC/AHA guideline significantly increased hypertension prevalence, primarily driven by SDH (8.64% to 25.59%) and IDH (2.42% to 6.93%).
• Treatment recommendation differences were minimal for IDH and ISH under the guidelines.
• All-cause mortality showed significant associations with SDH (HR 1.56) and ISH (HR 1.29) by ACC/AHA, but not IDH (HR 1.15).

Conclusions:

• Adopting the 2017 ACC/AHA guideline may improve hypertension control rates in Chinese adults.
• Careful consideration regarding antihypertensive drug therapy is necessary for the large population with IDH under the new guideline.
• Further research is warranted to optimize hypertension management strategies for diverse subtypes in China.