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Blood pressure per the 2017 ACC/AHA and 2018 ESC/ESH guidelines and heart failure risk: the Suita Study

Hypertension Research volume 46, pages 575–582 (2023)Cite this article

Abstract

Hypertension is a significant risk factor for heart failure (HF). Since hypertension definition varies across guidelines, identifying blood pressure (BP) categories that should be targeted to prevent HF is required. We, therefore, investigated the association between hypertension per the 2017 American College of Cardiology/American Heart Association (ACC/AHA) and 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines and HF risk. This prospective cohort study included randomly selected 2809 urban Japanese people from the Suita Study. Cox regression was used to assess HF risk, in the form of hazard ratios (HRs) and 95% confidence intervals (95% CIs), for different BP categories in both guidelines, compared to a reference category defined as systolic BP (SBP) <120 mmHg and diastolic BP (DBP) <80 mmHg. Within 8 years of median follow-up, 339 HF cases were detected. Per the 2017 ACC/AHA guidelines, hypertension I and II and isolated systolic hypertension were associated with increased HF risk: HRs (95% CIs) = 1.81 (1.33–2.47), 1.68 (1.24–2.27), and 1.64 (1.13–2.39), respectively. Per the 2018 ESC/ESH guidelines, high-normal BP, hypertension I, II, and III, and isolated systolic hypertension were associated with increased HF risk: HRs (95% CIs) = 1.88 (1.35–2.62), 1.57 (1.13–2.16), 2.10 (1.34–3.29), 2.57 (1.15–5.77), and 1.51 (1.04–2.19), respectively. In conclusion, hypertension and isolated systolic hypertension per the 2017 ACC/AHA and 2018 ESC/ESH guidelines and high-normal BP per the 2018 ESC/ESH guidelines are risk factors for HF.

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Acknowledgements

We would like to thank the Suita Medical Association, the members of Suita City Health Center, the staff of the Preventive Cardiology and Preventive Healthcare Departments, and all cohort members.

Funding

This study was supported by Grants-in-Aid for Scientific Research in Japan (B, No. 16H05252), the Intramural Research Fund for the cardiovascular diseases of the National Cerebral and Cardiovascular Center (20-4-9), the Japan Health Research Promotion Bureau (JH) (2019-(1)-1), the Japan Science and Technology Agency (JPMJPF2018), the Health and Labour Sciences Research Grants of the Ministry of Health, Labour and Welfare of Japan (20FA1002), and the Meiji Yasuda Research Institute and Life Insurance Company.

Author information

Authors and Affiliations

  1. Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan

    Ahmed Arafa, Yoshihiro Kokubo, Masayuki Teramoto, Rena Kashima & Keiko Shimamoto

  2. Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt

    Ahmed Arafa

  3. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA

    Masayuki Teramoto

  4. Department of Cardiovascular Pathophysiology and Therapeutics, Graduate School of Medicine, Osaka University, Suita, Japan

    Rena Kashima

  5. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK

    Yoko M. Nakao

  6. Department of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan

    Miki Matsuo & Fumiki Yoshihara

  7. Department of Heart Failure, National Cerebral and Cardiovascular Center, Suita, Japan

    Chisato Izumi

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Contributions

AA and YK were involved in the study design, data interpretation, and data analysis. All authors critically revised the report, commented on drafts of the manuscript, and approved the final manuscript.

Corresponding author

Correspondence to Ahmed Arafa.

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The authors declare no competing interests.

Ethical approval

The Institutional Review Board of the National Cerebral and Cardiovascular Center, Suita, Japan approved the study protocol (M19-005-8). The study was conducted per the Declaration of Helsinki. Written informed consent was obtained from all participants.

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Arafa, A., Kokubo, Y., Teramoto, M. et al. Blood pressure per the 2017 ACC/AHA and 2018 ESC/ESH guidelines and heart failure risk: the Suita Study. Hypertens Res 46, 575–582 (2023). https://doi.org/10.1038/s41440-022-01128-3

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