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, Ji Won Lee

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

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.

Original languageEnglish
Article number5134
JournalInternational journal of environmental research and public health
Volume16
Issue number24
DOIs
Publication statusPublished - 2019 Dec 2

Bibliographical note

Funding Information:
Acknowledgments: This work was supported by the pilot study of the Korea National Health and Nutrition Examination Survey linked Cause of death data by the Korea Centers for Disease Control and Prevention.

Funding Information:
Funding: This work was supported by the Bio and Medical Technology Development Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT, and Future Planning (NRF-2018R1D1A1B07049223), the Technology Innovation Program (20002781, A Platform for Prediction and Management of Health Risk Based on Personal Big Data and Lifelogging) funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea).

Publisher Copyright:
© 2019 by the authors. Licensee MDPI, Basel, Switzerland.

All Science Journal Classification (ASJC) codes

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

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