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Hypertension Criteria and the Early Detection of Vascular Aging in Youth
Yolandi Breet1,2, Annemarie Wentzel3,4, Wayne Smith3,4
1Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa. yolandi.breet@nwu.ac.za.
Insights
The 2023 ESC/ESH hypertension guidelines detect all blood pressure phenotypes, while the 2017 ACC/AHA guidelines better identify early vascular aging risk in young adults.
Area of Science:
- Cardiology
- Vascular Medicine
- Hypertension Research
Background:
- Hypertension is a major global health concern, contributing significantly to morbidity and mortality.
- Current hypertension management guidelines may miss early signs of target organ injury in young individuals.
- Early vascular aging (EVA) is a critical indicator of future cardiovascular risk.
Purpose of the Study:
- To compare the diagnostic accuracy of the 2017 ACC/AHA and 2023 ESC/ESH hypertension guidelines.
- To determine which guideline best identifies an increased risk of early vascular aging (EVA).
- To assess the impact of guideline definitions on blood pressure phenotypes and EVA risk distribution.
Main Methods:
- 1026 young adults (20-30 years) underwent office and ambulatory blood pressure monitoring.
- Carotid-femoral pulse wave velocity (PWV) measured to assess arterial stiffness and EVA risk.
- Multiple linear regression and ROC curve analysis used to correlate BP phenotypes with EVA and identify optimal thresholds.
Main Results:
- Pulse wave velocity showed significant associations with various pathological BP phenotypes under both guideline sets.
- The ESC/ESH criteria identified all pathological BP phenotypes (SHT, WCHT, MHT).
- The ACC/AHA criteria, with lower thresholds, appeared more sensitive for detecting increased EVA risk.
Conclusions:
- The 2023 ESC/ESH guidelines are more comprehensive in identifying all blood pressure phenotypes.
- The 2017 ACC/AHA guidelines, despite limitations, show promise for earlier detection of EVA risk.
- Optimizing hypertension criteria is crucial for early risk identification and intervention in young populations.
Introduction:
Hypertension is a leading risk factor of global morbidity and mortality. Reports indicate a rise in mortality linked to blood pressure (BP) levels exceeding 115/75 mmHg. Even with hypertension management based on redefined guidelines, many young individuals with early signs of target organ injury (TOI) may still go undetected AIM : We determined the most accurate diagnostic criteria of hypertension (using the 2017 ACC/AHA and the 2023 ESC/ESH guidelines) for detecting an increased risk of early vascular aging (EVA). We additionally estimated the effects of the guidelines' definitions on the distribution of BP phenotypes and risk of EVA.
Methods:
A total of 1026 men and women (aged 20-30 years) were included. The primary data collected included office- and ambulatory blood pressure (ABPM) measurement, and carotid-femoral pulse wave velocity (PWV). The upper 25th percentile of PWV was regarded as having an increased risk of EVA. The frequencies of hypertension and BP phenotypes were calculated according to both guidelines and correlated with TOI by multiple linear regression. Receiver operating characteristic (ROC) curves were constructed to determine the best BP threshold for detecting increased risk of EVA.
Results:
Pulse wave velocity was associated with all pathological BP phenotypes (SHT, WCHT and MHT), based on the ESC/ESH and with SHT and WCHT based on the ACC/AHA criteria (all p<0.024).
Conclusion:
The ESC/ESH criteria, but not the ACC/AHA criteria, is sensitive to identify all BP phenotypes. The lower thresholds advised by the ACC/AHA guidelines however seem to favour early detection of increased risk for EVA.
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