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Blood pressure categories defined by the 2017 ACC/AHA guideline and all-cause mortality: a national cohort study in China and meta-analysis

Journal of Human Hypertension volume 36, pages 95–105 (2022)Cite this article

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Abstract

The 2017 American College of Cardiology/American Heart Association guideline recommends a lowered threshold for hypertension diagnosis. Nonetheless, the association of blood pressure (BP) groups defined by the new guideline and all-cause mortality has not been fully estimated, especially in general Chinese. Based on the China Health and Retirement Longitudinal Study (CHARLS) during 2011–2018, 12,964 participants aged 45 years or older at baseline were enrolled for a follow-up of 7 years. Cox proportional hazards models were used to examine the relationship of BP classifications with all-cause mortality, with normal BP (<120/80 mmHg) as a reference. Afterwards, eligible studies shed light in this field were searched in public databases, and meta-analysis was conducted. In CHARLS, there were 41.21% and 16.08% individuals with stage 2 hypertension and stage 1 hypertension, respectively. During the follow-up, 1293 death occurred. The redefined stage 1 (130–139/80–89 mmHg) and stage 2 hypertension (≥140/≥90 mmHg) were found to have increased risk of death in the crude model, but only stage 2 hypertension maintained statistically significance after adjustment. Furthermore, meta-analysis including CHARLS and nine other prospective studies, with a total of 290,609 participants followed up for 3,081,532 person-years, resulted in similar results (combined hazard ratio (95% confidence interval) was 1.07 (0.99–1.15) for stage 1 hypertension, and 1.39 (1.25–1.53) for stage 2 hypertension). The present study detected that individuals with stage 2 and stage 1 hypertension had increased likelihood to die from any cause, but only the former association achieved statistically significance. Further cohorts with long-term follow-up duration are warranted, especially in China.

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The code used and/or analyzed during the current study is available from the corresponding author on reasonable request.

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Acknowledgements

This study is supported by the Natural Science Foundation of the Jiangsu Higher Education Institutions of China and a Project Funded by Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD). This analysis uses data or information from the Harmonized CHARLS data set and Codebook, Version C as of April 2018 developed by the Gateway to Global Aging Data. The development of the Harmonized CHARLS was funded by the National Institute on Ageing (R01 AG030153, RC2 AG036619, R03 AG043052). For more information, please refer to www.g2aging.org.

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  1. These authors contributed equally: Jiaxiang Wang, Jieyu Liu

Authors and Affiliations

  1. Department of Epidemiology and Biostatics, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China

    Jiaxiang Wang, Jieyu Liu, Haoyue Teng, Yushan Zhang, Xingxuan Dong & Jieyun Yin

  2. Zhuhai Center for Chronic Disease Control, Zhuhai, Guangdong, China

    Wei Chen

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Wang, J., Liu, J., Teng, H. et al. Blood pressure categories defined by the 2017 ACC/AHA guideline and all-cause mortality: a national cohort study in China and meta-analysis. J Hum Hypertens 36, 95–105 (2022). https://doi.org/10.1038/s41371-021-00495-7

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