Appropriateness of the 2017 ACC/AHA Guidelines: Applied to Data from the China National Stroke Screening and Prevention Project Study

Background: In November 2017, the American College of Cardiology/American Heart Association (ACC/AHA) updated their definition of hypertension from 140/90 mm Hg to 130/80 mm Hg. We sought to assess the situation of hypertension and the appropriateness of applying the new threshold to a geographically and ethnically diverse population. Methods: We analyzed selected data on 237,142 participants aged ≥40 who had blood pressure taken for the China National Stroke Screening and Prevention Project. Choropleth maps and logistic regression analyses were performed to estimate the prevalence, geographical distribution and risk factors of hypertension using both 2017 ACC/AHA guidelines and 2014 evidence based guidelines. Findings: The age- and sex-standardized prevalence of hypertension was 41.20% and 73.15% respectively, according to 2014 evidence based guidelines and 2017 ACC/AHA guidelines. The distribution of hypertension and risk factors changed little between guidelines, with data showing a high prevalence of hypertension around Bohai Gulf and in south central coastal areas using either definition. The age- and sex-standardized prevalence of newly labeled as hypertensive was 31.95%. Interestingly, the high prevalence region of newly labeled as hypertensive was found in the north China. Interpretation:  The prevalence of hypertension increased significantly on 2017 ACC/AHA guidelines compared to the prevalence when using 2014 evidence based guidelines, with high prevalence areas of newly labeled as hypertensive now seen mainly in north China. The present study suggests the new threshold maybe more appropriate in areas with relatively low temperatures and in North America, European countries. Funding Statement:  The China National Stroke Prevention Project was sponsored by the Ministry of Finance of the People’s Republic of China (issued by Finance and Social Security [2011] Document No. 61, Ministry of Finance). This work was supported by: the Fundamental Research Funds for the Central Universities, Huazhong University of Science and Technology, Wuhan, China, (2016YXMS215); the Innovation Committee of Shenzhen Science and Technology, “Demonstration Application of Cardiovascular and Cerebrovascular Disease Prevention and Control Based on Functional Community” (KJYY20170413162318686). Declaration of Interests: The authors declare "none." Ethics Approval Statement: The study protocol was approved by ethics committee of the XuanWu Hospital Institutional Review Board, Capital Medical University (Beijing, China). Written informed consent was obtained from all study participants. The screening work was conducted by trained clinics in the participants’ residential area according to a standard protocol.