Association of Blood Pressure Classification Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline With Risk of Heart Failure and Atrial Fibrillation. Issue 23 (22nd April 2021)

• Record Type: Journal Article
• Authors: Kaneko, Hidehiro; Yano, Yuichiro; Itoh, Hidetaka; Morita, Kojiro; Kiriyama, Hiroyuki; Kamon, Tatsuya; Fujiu, Katsuhito; Michihata, Nobuaki; Jo, Taisuke; Takeda, Norifumi; Morita, Hiroyuki; Node, Koichi; Carey, Robert M.; Lima, Joao A.C.; Oparil, Suzanne; Yasunaga, Hideo; Komuro, Issei
• Is Part Of: Circulation. Volume 143:Issue 23(2021)
• Page Start: 2244
• Page End: 2253
• Publication Date: 2021-04-22
• Subjects: atrial fibrillation -- epidemiology -- guidelines as topic -- heart failure -- hypertension; Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIRCULATIONAHA.120.052624
• Languages: English
• ISSNs: 0009-7322

Abstract

Abstract : Supplemental Digital Content is available in the text. Abstract : Background: Heart failure (HF) and atrial fibrillation (AF) are growing in prevalence worldwide. Few studies have assessed to what extent stage 1 hypertension in the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines is associated with incident HF and AF. Methods: Analyses were conducted with a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2018 (n=2 196 437; mean age, 44.0±10.9 years; 58.4% men). No participants were taking antihypertensive medication or had a known history of cardiovascular disease. Each participant was categorized as having normal BP (systolic BP <120 mm Hg and diastolic BP <80 mm Hg; n=1 155 885), elevated BP (systolic BP 120–129 mm Hg and diastolic BP <80 mm Hg; n=337 390), stage 1 hypertension (systolic BP 130–139 mm Hg or diastolic BP 80–89 mm Hg; n=459 820), or stage 2 hypertension (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg; n=243 342). Using Cox proportional hazards models, we identified associations between BP groups and HF/AF events. We also calculated the population attributable fractions to estimate the proportion of HF and AF events that would be preventable if participants with stage 1 and stage 2 hypertension were to have normal BP. Results: Over a mean follow-up of 1112±854 days, 28 056 incident HF and 7774 incident AF events occurred. After multivariable adjustment, hazard ratios for HF and AF events were 1.10 (95% CI, 1.05–1.15) and 1.07 (95% CI, 0.99–1.17), respectively, for elevated BP; 1.30 (95% CI, 1.26–1.35) and 1.21 (95% CI, 1.13–1.29), respectively, for stage 1 hypertension; and 2.05 (95% CI, 1.97–2.13) and 1.52 (95% CI, 1.41–1.64), respectively, for stage 2 hypertension versus normal BP. Population attributable fractions for HF associated with stage 1 and stage 2 hypertension were 23.2% (95% CI, 20.3%–26.0%) and 51.2% (95% CI, 49.2%–53.1%), respectively. The population attributable fractions for AF associated with stage 1 and stage 2 hypertension were 17.4% (95% CI, 11.5%–22.9%) and 34.3% (95% CI, 29.1%–39.2%), respectively. Conclusions: Both stage 1 hypertension and stage 2 hypertension were associated with a greater incidence of HF and AF in the general population. The American College of Cardiology/American Heart Association BP classification system may help identify adults at higher risk for HF and AF events.