The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline lowered the BP thresholds for defining hypertension compared with the Seventh Report of the Joint National Committee (JNC7) guideline.

A team of researchers, including Mr. Bharat Poudel, researcher, Ms. Swati Sakhuja, PhD student, Dr. Cora (Beth) Lewis, professor and chair, and Dr. Paul Muntner, professor, all from the department of epidemiology at UAB’s School of Public Health, analyzed clinic and ambulatory BP monitoring data from 717 Coronary Artery Risk Development in Young Adults study participants and compared the prevalence of clinic and out-of-clinic BP phenotypes using thresholds from the 2017 ACC/AHA and JNC7 guidelines.

Among participants not taking antihypertensive medication and according to the JNC7 and 2017 ACC/AHA guidelines, 11.1 and 30.1 percent of participants had clinic hypertension, 37.5 and 57.9 percent had awake hypertension, 35.7 and 58.1 percent had asleep hypertension, and 35.7 and 58.6 percent had 24-h hypertension, respectively. According to the JNC7 and 2017 ACC/AHA guideline definitions, 1.9 and 3.2 percent had white-coat hypertension, 28.2 and 31.0 percent had masked hypertension and 9.3 and 26.9 percent had sustained hypertension, respectively.

Among participants taking antihypertensive medication and when defined using the JNC7 and 2017 ACC/AHA guideline BP thresholds, 18.6 and 45.6 percent had uncontrolled clinic BP, 48.1 and 62.5 percent had uncontrolled awake BP, 48.1 and 70.2 percent had uncontrolled asleep BP and, 47.7 and 65.3 percent had uncontrolled 24-h BP, respectively. Using JNC7 and 2017 ACC/AHA guideline BP thresholds, the prevalence was 1.4 and 5.2 percent for white-coat effect, 30.9 and 22.5 percent for masked uncontrolled hypertension, and 17.2 and 40.0 percent for sustained uncontrolled BP, respectively.

The authors concluded that the 2017 ACC/AHA guideline results in a substantially higher prevalence of awake, asleep, 24-h, and sustained hypertension.

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