Impact of new hypertension guidelines on target organ damage screening in a Shanghai community-dwelling population

Qian Wang, Huijuan Chao, Shuping Zheng, Isabella Tan, Mark Butlin, Alberto Avolio, Junli Zuo

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Recently, the 2017 ACC/AHA released new hypertension guidelines and proposed a redefinition of hypertension from 140/90 to 130/80 mm Hg. This study assesses the impact of the lower threshold for hypertension diagnosis on the association of hypertension with target organ damage (TOD). Health checks were conducted in a community-dwelling population in Shanghai in 2017 (N = 10 826; 43.26% mean, age 62 ± 12 years [range 29-95 years]). Subclinical TOD indices were quantified in terms of left ventricular hypertrophy (LVH) by electrocardiogram (Sokolow-Lyon standard), estimated glomerular filtration rate (eGFR), and presence of proteinuria. Information on clinical TOD was obtained by questionnaire. Arteriosclerotic cardiovascular disease (ASCVD) was determined by the 2013 ACC/ AHA recommended guidelines. Compared to the higher threshold (140/90 mm Hg), the lower threshold (130/80 mm Hg) was associated with variable rates of increased detection of hypertension and TOD: (a) Hypertension: incidence of hypertension, 29.5% (51.8%-81.5%) increase in persons with hypertension if the threshold of 130/80 mm Hg is used; (b) Subclinical TOD: LVH, 20.8%; eGFR (30-60 mL/min per 1.73 m2), 23.7%; proteinuria, 23.5%; (c) Clinical TOD: chronic kidney disease (CKD) IV (eGFR<30 mL/min per 1.73 m2), 3.1%; diabetes (fasting glucose ≥7.0 mmol/L or HbA1C>7.0%), 24.3%; stroke, 26.4%; chronic heart disease, 28.1%; acute myocardial infarction, 19.5% (69.4% to 88.9% of total of 36); ASCVD ≥10%, 29.3%. The lower threshold was associated with a significantly higher detection rate of clinical and subclinical TOD of approximately 20% compared to the higher threshold. 15%-20% of TOD and 29% of ASCVD were also found below the lower threshold of hypertension.

LanguageEnglish
Pages1450-1455
Number of pages6
JournalJournal of Clinical Hypertension
Volume21
Issue number10
DOIs
Publication statusPublished - 1 Oct 2019

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Independent Living
Guidelines
Hypertension
Population
Glomerular Filtration Rate
Cardiovascular Diseases
Left Ventricular Hypertrophy
Proteinuria
Chronic Renal Insufficiency
Heart Diseases
Fasting
Electrocardiography
Chronic Disease
Stroke
Myocardial Infarction
Glucose

Keywords

  • arteriosclerotic cardiovascular disease (ASCVD)
  • high threshold of hypertension
  • low threshold of hypertension
  • new hypertension guidelines
  • target organ damage

Cite this

@article{1456b319d4824081a14c677ede45e351,
title = "Impact of new hypertension guidelines on target organ damage screening in a Shanghai community-dwelling population",
abstract = "Recently, the 2017 ACC/AHA released new hypertension guidelines and proposed a redefinition of hypertension from 140/90 to 130/80 mm Hg. This study assesses the impact of the lower threshold for hypertension diagnosis on the association of hypertension with target organ damage (TOD). Health checks were conducted in a community-dwelling population in Shanghai in 2017 (N = 10 826; 43.26{\%} mean, age 62 ± 12 years [range 29-95 years]). Subclinical TOD indices were quantified in terms of left ventricular hypertrophy (LVH) by electrocardiogram (Sokolow-Lyon standard), estimated glomerular filtration rate (eGFR), and presence of proteinuria. Information on clinical TOD was obtained by questionnaire. Arteriosclerotic cardiovascular disease (ASCVD) was determined by the 2013 ACC/ AHA recommended guidelines. Compared to the higher threshold (140/90 mm Hg), the lower threshold (130/80 mm Hg) was associated with variable rates of increased detection of hypertension and TOD: (a) Hypertension: incidence of hypertension, 29.5{\%} (51.8{\%}-81.5{\%}) increase in persons with hypertension if the threshold of 130/80 mm Hg is used; (b) Subclinical TOD: LVH, 20.8{\%}; eGFR (30-60 mL/min per 1.73 m2), 23.7{\%}; proteinuria, 23.5{\%}; (c) Clinical TOD: chronic kidney disease (CKD) IV (eGFR<30 mL/min per 1.73 m2), 3.1{\%}; diabetes (fasting glucose ≥7.0 mmol/L or HbA1C>7.0{\%}), 24.3{\%}; stroke, 26.4{\%}; chronic heart disease, 28.1{\%}; acute myocardial infarction, 19.5{\%} (69.4{\%} to 88.9{\%} of total of 36); ASCVD ≥10{\%}, 29.3{\%}. The lower threshold was associated with a significantly higher detection rate of clinical and subclinical TOD of approximately 20{\%} compared to the higher threshold. 15{\%}-20{\%} of TOD and 29{\%} of ASCVD were also found below the lower threshold of hypertension.",
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Impact of new hypertension guidelines on target organ damage screening in a Shanghai community-dwelling population. / Wang, Qian; Chao, Huijuan; Zheng, Shuping; Tan, Isabella; Butlin, Mark; Avolio, Alberto; Zuo, Junli.

In: Journal of Clinical Hypertension, Vol. 21, No. 10, 01.10.2019, p. 1450-1455.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Impact of new hypertension guidelines on target organ damage screening in a Shanghai community-dwelling population

AU - Wang, Qian

AU - Chao, Huijuan

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AU - Tan, Isabella

AU - Butlin, Mark

AU - Avolio, Alberto

AU - Zuo, Junli

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