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Blood pressure per the 2017 ACC/AHA and 2018 ESC/ESH guidelines and heart failure risk: the Suita Study

Ahmed Arafa1,2, Yoshihiro Kokubo3, Masayuki Teramoto3,4

  • 1Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan. ahmed011172@med.bsu.edu.eg.

Hypertension Research : Official Journal of the Japanese Society of Hypertension
|January 7, 2023
PubMed

Insights

Hypertension increases heart failure risk. Different guidelines define hypertension differently, impacting risk assessment. This study compared ACC/AHA and ESC/ESH guidelines, finding both identify key blood pressure categories linked to heart failure development.

Area of Science:

  • Cardiology
  • Epidemiology
  • Public Health

Background:

  • Hypertension is a major risk factor for heart failure (HF).
  • Discrepancies in hypertension definitions across international guidelines complicate risk stratification for HF prevention.
  • Standardized identification of blood pressure (BP) categories for HF prevention is needed.

Purpose of the Study:

  • To investigate the association between hypertension, as defined by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) and 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines, and the risk of developing heart failure (HF).

Main Methods:

  • A prospective cohort study involving 2809 randomly selected urban Japanese participants from the Suita Study.
  • Cox regression analysis was employed to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for HF risk across different BP categories.
  • BP categories were compared against a reference of systolic BP <120 mmHg and diastolic BP <80 mmHg, with a median follow-up of 8 years.

Main Results:

  • During the follow-up, 339 cases of heart failure were identified.
  • According to ACC/AHA 2017 guidelines, hypertension stages I and II and isolated systolic hypertension were significantly associated with increased HF risk (HRs ranging from 1.64 to 1.81).
  • According to ESC/ESH 2018 guidelines, high-normal BP, hypertension stages I, II, and III, and isolated systolic hypertension were associated with elevated HF risk (HRs ranging from 1.51 to 2.57).

Conclusions:

  • Hypertension and isolated systolic hypertension, as defined by both ACC/AHA 2017 and ESC/ESH 2018 guidelines, are confirmed risk factors for heart failure.
  • High-normal blood pressure, per the ESC/ESH 2018 guidelines, also emerged as a significant risk factor for heart failure.
  • These findings underscore the importance of guideline-specific BP management for heart failure prevention.

Keywords:
Blood pressureHeart failureHypertensionJapanProspective cohort

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