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

Objectives: Recent guidelines propose a redefinition of hypertension from 140/90 to 130/80 mmHg. This study assesses the impact of the new threshold of hypertension diagnosis on the association of hypertension with target organ damage (TOD). Methods: Health checks were conducted in a community-dwelling population in Shanghai in 2017 (N = 10,826; 43.26% men, age 62.2 ± 12.0 years [range 29–95]). 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. Results: Compared to the high threshold (140/90 mmHg), the lower threshold (130/80 mmHg) was associated with variable rates of increased detection of hypertension and TOD: (i) Hypertension: incidence of hypertension for the whole cohort, 29.5% (51.8% to 81.5%) (ii) Subclinical TOD: LVH, 20.8% (65.6% to 86.4% of total of 684); eGFR (30–60 ml/min per 1.73m2, 23.7% (60.9% to 84.6% of total of 553); proteinuria, 23.5% (65.6% to 86.4% of total of 553) (iii) Clinical TOD: chronic kidney disease (eGFR < 30 ml/min per 1.73m2), 3.1% (68.8% to 71.9% of total of 32); diabetes (fasting glucose≥7.0 mmol/l or HbA1C > 7.0%), 24.3% (65.5% to 89.8% of total of 1107); stroke, 26.4% (56.4% to 82.8% of total of 349); chronic heart disease, 28.1% (55.1% to 83.2% of total of 394); acute myocardial infaction,19.5% (69.4% to 88.9% of total of 36). Conclusion: The lower threshold of hypertension of 130/80 was associated with a significantly higher detection rate of clinical and subclinical TOD of approximately 20% compared to the higher threshold of 140/90. In the same cohort, some 15%–20% of TOD was also found below the lower threshold of hypertension.