Hypertension Defined by 2017 ACC/AHA Guideline, Ideal Cardiovascular Health Metrics, and Risk of Cardiovascular Disease: A Nationwide Prospective Cohort Study
Shujing Wu, Yu Xu, Ruizhi Zheng, Jieli Lu, Mian Li, Li Chen, Yanan Huo, Min Xu, Tiange Wang, Zhiyun Zhao, Shuangyuan Wang, Hong Lin, Meng Dai, Di Zhang, Jingya Niu, Guijun Qin, Li Yan, Qin Wan, Lulu Chen, Lixin Shi, Ruying Hu, Xulei Tang, Qing Su, Xuefeng Yu, Yingfen Qin, Gang Chen, Zhengnan Gao, Guixia Wang, Feixia Shen, Zuojie Luo, Yuhong Chen, Yinfei Zhang, Chao Liu, Youmin Wang, Shengli Wu, Tao Yang, Qiang Li, Yiming Mu, Jiajun Zhao, Yufang Bi, Weiqing Wang, Guang Ning
Abstract
BACKGROUND: The updated definition of hypertension by the American College of Cardiology (ACC) and the American Heart Association (AHA) is an important paradigm shift and has lead to extensive discussion. We aimed to examine the association between the updated blood pressure (BP) categories and the risk of cardiovascular diseases (CVDs) with potential modifications from other cardiovascular health metrics (CVHMs). METHODS: This prospective study included 91,204 participants ≥40 years recruited from 20 community sites across mainland China. Participants were followed up during 2010-2016 for CVD events including nonfatal myocardial infarction, stroke, heart failure, and cardiovascular death. BP categories were defined according to the 2017 ACC/AHA guideline and CVHMs included smoking, physical activity, diet, body-mass index, total cholesterol, and fasting glucose. FINDINGS: for interaction <0·05). INTERPRETATION: Stage 1 hypertension defined by the ACC/AHA identifies individuals at increased CVD risk, which can be attenuated by achieving more preferable cardiovascular health, especially in adults aged <60 years.