Insight Into Blood Pressure Targets for Universal Coverage of Hypertension Services in Iran: The 2017 Acc/Aha Versus Jnc 8 Hypertension Guidelines Publisher Pubmed



Mahdavi M^{1, 2} ; Parsaeian M³ ; Mohajer B⁴ ; Modirian M⁴ ; Ahmadi N⁴ ; Yoosefi M⁴ ; Mehdipour P⁴ ; Djalalinia S⁵ ; Rezaei N⁴ ; Haghshenas R^{4, 6} ; Pazhuheian F⁴ ; Madadi Z⁴ ; Sabooni M⁷ ; Razi F⁸ Show All Authors Show Affiliations
Source: BMC Public Health Published:2020

Abstract

Background: We compared the prevalence, awareness, treatment, and control of hypertension in Iran based on two hypertension guidelines; the 2017 ACC/AHA-with an aggressive blood pressure target of 130/80 mmHg-A nd the commonly used JNC8 guideline cut-off of 140/90 mmHg. We shed light on the implications of the 2017 ACC/AHA for population subgroups and high-risk individuals who were eligible for non-pharmacologic and pharmacologic therapies. Methods: Data was obtained from the Iran national STEPS 2016 study. Participants included 27,738 adults aged ≥25 years as a representative sample of Iranians. Regression models of survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension. Results: The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) based on the 2017 ACC/AHA. The percentage of awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0), respectively, by applying the 2017 ACC/AHA. Based on the new guideline, adults aged 25-34 years had the largest increase in prevalence (from 7.3 to 30.7%). They also had the lowest awareness and treatment rate, contrary to the highest control rate (36.5%) between age groups. Compared with JNC8, based on the 2017 ACC/AHA, 24, 15, 17, and 11% more individuals with dyslipidaemia, high triglycerides, diabetes, and cardiovascular disease events, respectively, fell into the hypertensive category. Yet, based on the 2017 ACC/AHA, 68.2% of individuals falling into the hypertensive category were eligible for receiving pharmacologic therapy (versus 95.7% in JNC8). LDL cholesterol< 130 mg/dL, sufficient physical activity (Metabolic Equivalents≥600/week), and Body Mass Index were found to change blood pressure by-3.56(-4.38,-2.74),-2.04(-2.58,-1.50), and 0.48(0.42, 0.53) mmHg, respectively. Conclusions: Switching from JNC8 to 2017 ACC/AHA sharply increased the prevalence and drastically decreased the awareness, treatment, and control in Iran. Based on the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category; these individuals might benefit from earlier interventions such as lifestyle modifications. The low control rate among individuals receiving treatment warrants a critical review of hypertension services. © 2020 The Author(s).