Association of Blood Pressure Classification Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline with Risk of Heart Failure and Atrial Fibrillation.

Heart failure (HF) and atrial fibrillation (AF) are growing in prevalence worldwide. Few studies have assessed to what extent stage 1 hypertension in the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) blood pressure (BP) guidelines is associated with incident HF and AF. Analyses were conducted using a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2018 (n=2,196,437; mean age, 44.0±10.9 years; 584% men). No participants were taking antihypertensive medication or had a known history of cardiovascular disease. Each participant was categorized as having normal BP (systolic BP [SBP]<120 mm Hg and diastolic BP [DBP]<80 mm Hg; n=1,155,885); elevated BP (SBP 120-129 mm Hg and DBP<80 mm Hg; n=337,390); stage 1 hypertension (SBP 130-139 mm Hg or DBP 80-89 mm Hg; n=459,820); or stage 2 hypertension (SBP≥140 mm Hg or DBP≥90 mm Hg; n=243,342). Using Cox proportional hazards models, we identified associations between BP groups and HF/AF events. We also calculated the population attributable fractions (PAFs) to estimate the proportion of HF and AF events that would be preventable if participants with stage 1 and stage 2 hypertension were to have normal BP. Over a mean follow-up of 1,112±854 days, 28,056 incident HF and 7,774 incident AF events occurred. After multivariable adjustment, hazard ratios for HF and AF events were 1.10 (95% Confidence interval [CI], 1.05-1.15) and 1.07 (95% CI, 0.99-1.17), respectively, for elevated BP; 1.30 (95% CI, 1.26-1.35) and 1.21 (95% CI, 1.13-1.29), respectively, for stage 1 hypertension; and 2.05 (95% CI, 1.97-2.13) and 1.52 (95% CI, 1.41-1.64), respectively, for stage 2 hypertension vs normal BP. PAFs for HF associated with stage 1 and stage 2 hypertension were 23.2% (95% CI, 20.3%-26.0%) and 51.2% (95% CI, 49.2%-53.1%), respectively. The PAFs for AF associated with stage 1 and stage 2 hypertension were 17.4% (95% CI, 11.5%-22.9%) and 34.3% (95% CI, 29.1%-39.2%), respectively. Both stage 1 and stage 2 hypertension were associated with a greater incidence of HF and AF in the general population. The ACC/AHA BP classification system may help identify adults at higher risk for HF and AF events.