Comparison of the JNC7 and 2017 American College of Cardiology/American Heart Association Guidelines for the Management of Hypertension in Koreans: Analysis of Two Independent Nationwide Population-Based Studies

Won-Jun Choi, Hye-Sun Lee, Jung Hwa Hong, Hyuk-Jae Chang and Ji-Won Lee
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Won-Jun Choi: Family Medicine, Graduate School, Yonsei University College of Medicine, Seoul 03722, Korea
Hye-Sun Lee: Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 06273, Korea
Jung Hwa Hong: Institute of Health Insurance & Clinical Research, National Health Insurance Service Ilsan Hospital, Seoul 10444, Korea
Hyuk-Jae Chang: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Korea
Ji-Won Lee: Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea

IJERPH, 2019, vol. 16, issue 24, 1-13

Abstract: The optimal blood pressure (BP) guidelines in Asian populations have not been determined. We compared all-cause and cardiovascular mortality based on the Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. The National Health Insurance System-National Health Screening Cohort (NHIS-HEALS) and Korea National Health and Nutrition Examination Survey (KNHANES) were utilized. BPs were classified into three groups according to each guideline, and survival rates were analyzed with Kaplan-Meier curves and log-rank tests. Hazard ratios (HRs) were calculated using multivariable cox regression analyses, and the discriminatory ability for clinical outcomes was assessed by Harrell’s C-indexes. The JNC7 guidelines demonstrated a linear association between BP levels and survival outcomes. Adjusted HRs from the JNC7 guidelines differentiated the hypertension group (≥140/90) from the pre (130/80–139/89) and normal (<130 and <80) BP groups in clinical outcomes. In contrast, the 2017 ACC/AHA guidelines showed inconsistent survival outcomes according to BP classification (normal: <120 and <80, elevated: 120–129, and <80, and HTN: ≥130/80). According to Harrell’s C-indexes, the JNC7 guidelines had greater discrimination ability in survival outcomes in the NHIS-HEALS dataset. Our results suggest that the JNC7 guidelines are more appropriate than the 2017 ACC/AHA guidelines in Korean populations.

Keywords: hypertension; mortality; guidelines; blood pressure (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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