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Clustering of risk factors and the risk of new-onset hypertension defined by the 2017 ACC/AHA Hypertension Guideline

Journal of Human Hypertension volume 34, pages 372–377 (2020)Cite this article

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Abstract

The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) lowered the diagnostic criteria for hypertension. We aimed to explore whether clustering of multiple risk factors are associated with the risk of new-onset hypertension defined by the 2017 ACC/AHA Hypertension Guideline. Subjects who attended ≥2 annual health examinations without baseline hypertension and cardiovascular disease were included. Hypertension was defined according to the 2017 ACC/AHA Hypertension Guideline. Seven predefined risk factors, including age, resting heart rate, overweight or obesity, dyslipidemia, hyperuricemia, impaired glucose regulation, and a poor estimated glomerular filtration rate, were analyzed. A composite, individual-level, cumulative score incorporating these seven risk factors (no = 0 point; yes = 1 point; total range of 0–7 points) was calculated. The association between the cumulative score and the risk of hypertension was analyzed using a Cox regression model. A total of 4424 (21.6%) of 20,190 subjects included had new-onset hypertension during a follow-up duration of 3.6 years. Compared with subjects with 0 points, the adjusted hazard ratios (95% confidence intervals) for the development of hypertension for those with 1, 2, 3, and ≥4 points were 1.21 (1.07–1.38), 1.34 (1.19–1.52), 1.44 (1.26–1.63), and 1.64 (1.44–1.87), respectively (P < 0.001), after adjustment for sex and baseline blood pressure. Age, resting heart rate, overweight/obesity, dyslipidemia, hyperuricemia, impaired glucose regulation, and a poor estimated glomerular filtration rate are associated with an increased risk of future hypertension. When these factors are combined, there is an accumulated increase in risk.

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Acknowledgements

YH received Research Funding from the Science and Technology Innovation Project from Foshan, Guangdong (FS0AA-KJ218-1301-0006), Scientific research start-up plan of Southern Medical University (CX2018N202) the Clinical Research Startup Program of Shunde Hospital, Southern Medical University (CRSP2019001). DM received Research Funding from Guangzhou Science and Technology Project Industry, University and Research Collaborative Innovation Major Project (201704020106), Clinical Research and Cultivation Project of Southern Medical University (LC2016PY054).

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  1. These authors contributed equally: Yuli Huang, Meng Dai, Zhihui Deng

Authors and Affiliations

  1. State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China

    Yuli Huang, Zhihui Deng, Xingfu Huang, Hanlin Li, Yujia Bai, Qiong Zhan, Qingchun Zeng & Dingli Xu

  2. Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, PR China

    Yuli Huang

  3. Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, PR China

    Meng Dai, Chuanjie Yan & Ping Ouyang

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  1. Yuli Huang
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Correspondence to Dingli Xu.

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Huang, Y., Dai, M., Deng, Z. et al. Clustering of risk factors and the risk of new-onset hypertension defined by the 2017 ACC/AHA Hypertension Guideline. J Hum Hypertens 34, 372–377 (2020). https://doi.org/10.1038/s41371-019-0232-9

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