Impact of 2017 ACC/AHA Guideline on Prevalence, Awareness, Treatment, Control and Risk Factors of Hypertension: a Population-based, Cross-sectional Study in Iran

Abstract Background: In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) provided a new guideline for hypertension prevention and management. We aimed to update the prevalence, awareness, control and risk factors of hypertension based on this guideline and to estimate the number of people who are eligible for non-pharmacologic and pharmacologic intervention. Methods: This population-based, cross-sectional study was conducted in Khuzestan, a large province in the southwest of Iran. Comprehensive information about the potential risk factors of hypertension was collected and blood pressure, blood biomarkers, and anthropometric were measured. Moreover, the dietary pattern was evaluated in 10% of the participants, using a qualitative food frequency questionnaire.Results: A total number of 30,506 individuals aged 20-65 years was included in this study. In comparison to previous guideline (JNC8), the prevalence of hypertension in Khuzestan dramatically increased by 27.04% after implementation of ACC/AHA (15.81% vs 42.85%), which was more dominant in the male population and the 50-59 age group. The sex and age adjustment of the hypertension prevalence was estimated to be 39.40%. The number of individuals required antihypertensive treatment was slightly increased from 15.53% to 21.18%; however, the level of awareness and control dramatically dropped by 23.17% & 31.78%, respectively. All hypertension-related risk factors remained significant after applying the new guideline; however, the strength of the association was reduced in the risk factors like age, waist-hip ratio, body mass index, alcohol consumption, water pipe usage, and physical activity. Similarity, the association between hypertension and history of diabetes, and cardiovascular diseases were decreased by 38%, and 62%, respectively.Conclusions: In the ACC/AHA guideline, a higher number of individuals with the pre-hypertension condition had been shifted into the hypertension category and the level of awareness, treatment, and control was dramatically fallen, which highlight a great need to expand the public health infrastructure for further managing the substantial increase in the public health burden of hypertension.