Increased Risk of Hypertension in Young Adults in Southwest China: Impact of the 2017 ACC/AHA High Blood Pressure Guideline

  • Dan Li
  • Xiaofang Zeng
  • Yi Huang
  • Han Lei
  • Ge Li
  • Nan Zhang
  • Wei HuangEmail author
Guidelines/Clinical Trials/Meta-Analysis (William J. Kostis, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Guidelines/Clinical Trials/Meta-Analysis


Purpose of Review

To examine the impact of the new 2017 ACC/AHA hypertension guideline on the prevalence of hypertension, its constituent ratio, and their associated factors in southwest China.

Recent Findings

A total of 14,220 permanent residents ≥ 18 years were enrolled in this survey. According to the 2017 ACC/AHA hypertension guideline, the hypertension prevalence was substantially increased (46.9% vs. 24.5%); consistent across different age and gender groups, while the hypertension awareness (23.8% vs. 45.6%); treatment (18.6% vs. 35.5%); control (2.3% vs. 11.2%); and control among treatment (9.6% vs. 24.0%) patients were decreased in southwest of China. In our cohort, 31.1% participants were newly diagnosed as hypertension. Young adults accounted considerable proportion in this newly diagnosed hypertension population. The proportion of young hypertensive individuals substantially increased, whereas those of the older hypertensive subjects decreased. Among the hypertensive subjects aged ≥ 65 years undergoing treatment, 90% of the elderly subjects were not eligible for hypertension control and 32.5% have systolic blood pressure control at 130–149 mmHg, and thus need to intensify antihypertensive treatment according to 2017 ACC/AHA hypertension guideline. Smoking, drinking, body fat percentage, and body mass index were considered the factors associated with hypertension according to the Chinese hypertension guideline but not in the 2017 ACC/AHA hypertension guideline.


The adoption of the 2017 ACC/AHA hypertension guideline will substantially increase hypertension prevalence in southwest of China. The new definition of hypertension implies that more young adults will likely suffer from high cardiovascular risks, while additional one third of elder hypertensive subjects will likely need intensified antihypertension treatments.


Hypertension Prevalence Control rate 2017 ACC/AHA hypertension guideline Chinese hypertension guideline 


Compliance with Ethical Standards

Conflict of Interest

This study was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University and all subjects signed informed consent for data collection and analyses prior to participation.

Dan Li, Xiaofang Zeng, Yi Huang, Han Lei, Ge Li, Nan Zhang, and Wei Huang declare that they no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Xu X, Byles J, Shi Z, McElduff P, Hall J. Dietary pattern transitions, and the associations with BMI, waist circumference, weight and hypertension in a 7-year follow-up among the older Chinese population: a longitudinal study. BMC Public Health. 2016;16(743):743. Scholar
  2. 2.
    Dzau V, Braunwald E. Resolved and unresolved issues in the prevention and treatment of coronary artery disease: a workshop consensus statement. Am Heart J. 1991;121(1):1244–63. Scholar
  3. 3.
    RS V, MG L, EP L, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. ACC Curr J Rev. 2001;11(2):31–1. Scholar
  4. 4.
    Zhou M, Wang H, Zhu J, Chen W, Wang L, Liu S, et al. Cause-specific mortality for 240 causes in China during 1990–2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet. 2016;387(10015):251–72. Scholar
  5. 5.
    World Health Organization. A global brief on hypertension : silent killer, global public health crisis: World Health Day 2013. World Health Organization. 2013.
  6. 6.
    Feng XL, Pang M, Beard J. Health system strengthening and hypertension awareness, treatment and control: data from the China Health and Retirement Longitudinal Study. Bull World Health Organ. 2014;92(1):29–41. Scholar
  7. 7.
    Liu L, Wang D, Wong KS, et al. Stroke and stroke care in China: huge burden, significant workload, and a national priority. Stroke. 2011;42(12):3651–4. Scholar
  8. 8.
    Yang G, Kong L, Zhao W, Wan X, Zhai Y, Chen LC, et al. Emergence of chronic non-communicable diseases in China. Lancet. 2008;372(9650):1697–705. Scholar
  9. 9.
    Lewington S, Lacey B, Clarke R, Guo Y, Kong XL, Yang L, et al. The burden of hypertension and associated risk for cardiovascular mortality in China. JAMA Intern Med. 2016;176(4):524–32. Scholar
  10. 10.
    •• Li Y, Yang L, Wang L, et al. Burden of hypertension in China: a nationally representative survey of 174,621 adults. Int J Cardiol. 2017;227:516–23. This epidemiological study describes the severe burden of hypertension in China from the aspects of hypertension prevalence, awareness, treatment, and control rates. CrossRefPubMedGoogle Scholar
  11. 11.
    •• Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J. Am. Coll. Cardiol. 2018;71(19):e127–248. This comprehensive guideline redefines the hypertension criteria which will have a major impact on the assessment and management of hypertension around the world. CrossRefPubMedGoogle Scholar
  12. 12.
    •• Muntner P, Carey RM, Gidding S, et al. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation. 2018;137(2):109–18. This article carefully analyzes the potential impact of new hypertension guidelines on the assessment and management of hypertension in the USA. CrossRefPubMedGoogle Scholar
  13. 13.
    Liu X, Gu W, Li Z, Lei H, Li G, Huang W. Hypertension prevalence, awareness, treatment, control, and associated factors in Southwest China: an update. J Hypertens. 2017;35(3):637–44. Scholar
  14. 14.
    Wang JG. Chinese hypertension guidelines. Pulse (Basel). 2015;3(1):14–20. Scholar
  15. 15.
    • Yang C, Wang J, Gao B, et al. Prevalence and treatment of hypertension in China: impacts of 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline. Sci Bull. 2018;63(8):488–93. This article analyzes the impact of new guidelines on hypertension prevalence and treatment in China. CrossRefGoogle Scholar
  16. 16.
    • Khera R, Lu Y, Lu J, et al. Impact of 2017 ACC/AHA guidelines on prevalence of hypertension and eligibility for antihypertensive treatment in United States and China: nationally representative cross sectional study. Bmj. 2018;362:k2357. The study analyzes the effects of the 2017 ACC/AHA guidelines on the prevalence of hypertension and antihypertensive treatment in the USA and China. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. Minerva Med. 2008;100(1):25. Scholar
  18. 18.
    Listed N. Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Prospective studies collaboration. Lancet. 1995; 346(8991-8992):1647–1653.
  19. 19.
    Franklin SS, Wong ND, Kannel WB. Age-specific relevance of usual blood pressure to vascular mortality. Lancet. 2002;361(9366):1389–90. Scholar
  20. 20.
    Group SR, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103–16. Scholar
  21. 21.
    Kearney PM, Whelton M, Reynolds K, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2016;42(8):2103–16. Scholar
  22. 22.
    Group SS, Benavente OR, Coffey CS, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013;382(9891):507–15. Scholar
  23. 23.
    Martell-Claros N, Cruz JJDL. Manidipine for hypertension not controlled by dual therapy in patients with diabetes mellitus. Clin Drug Investig. 2011;31(6):427–34. Scholar
  24. 24.
    •• Lacey B, Lewington S, Clarke R, et al. Age-specific association between blood pressure and vascular and non-vascular chronic diseases in 0·5 million adults in China: a prospective cohort study. Lancet Global Health. 2018;6(6):e641–9. This study analyzes the age-specific association between blood pressure and vascular and nonvascular chronic diseases in China and suggest the highly association of blood pressure with intracerebral haemorrhage and ischaemic stroke in Chinese population. CrossRefPubMedGoogle Scholar
  25. 25.
    •• Messerli FH, Bangalore S, Messerli AW. Age, blood pressure targets, and guidelines: rift between those who preach, those who teach, and those who treat? Circulation. 2018;138(2):128–30. This very useful review describes the effect of age on blood pressure and the blood presuure for the elder people.. CrossRefPubMedGoogle Scholar
  26. 26.
    Rakugi H, Ogihara T, Goto Y, et al. Comparison of strict- and mild-blood pressure control in elderly hypertensive patients: a per-protocol analysis of JATOS. Hypertens Res. 2010;33(11):1124–8. Scholar
  27. 27.
    Somes GW, Pahor M, Shorr RI, Cushman WC, Applegate WB. The role of diastolic blood pressure when treating isolated systolic hypertension. Arch Int Med. 1999;159(17):2004. Scholar
  28. 28.
    Peng J, Lu F, Wang Z, Zhong M, Sun L, Hu N, et al. Excessive lowering of blood pressure is not beneficial for progression of brain white matter hyperintensive and cognitive impairment in elderly hypertensive patients: 4-year follow-up study. J Am Med Dir Assoc. 2014;15(12):904–10. Scholar
  29. 29.
    Liu P, Zheng JG. Blood pressure targets in the hypertensive elderly. Chin Med J. 2017;130(16):1968. Scholar
  30. 30.
    Chaudhry KN, Chavez P, Gasowski J, et al. Hypertension in the elderly: some practical considerations. Cleve Clin J Med. 2012;79(10):694–704. Scholar
  31. 31.
    Hollenberg NK. Hypertension in an aging population: problems and opportunities. Am J Med. 1991;90(4B):1S–2S. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Dan Li
    • 1
  • Xiaofang Zeng
    • 1
  • Yi Huang
    • 1
  • Han Lei
    • 1
  • Ge Li
    • 2
  • Nan Zhang
    • 1
  • Wei Huang
    • 1
    Email author
  1. 1.Department of Cardiologythe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
  2. 2.Public Health School of Chongqing Medical University ChongqingChongqingChina

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