부산대학교 도서관

Introduction: In 2017, the American Heart Association (AHA)/ American College of Cardiology (ACC) revised guidelines for diagnosis of hypertension. The differential impact on prevalence of hypertension among women across high- (United States) and middle-income countries (India) is not known.Hypothesis: There are regional differences in the change in prevalence of hypertension with the new 2017 ACC/AHA guidelines among women.Methods: We used data from National Family Health Survey (NFHS)-4, and the National Health and Nutrition Examination Survey (NHANES) 2015-16 to estimate prevalence of hypertension among non-pregnant women aged 18-49 years in India and the United States, respectively. Both surveys are conducted by respective federal governments to estimate national health status. Hypertension was defined as an average systolic BP (SBP) ≥130 or diastolic BP (DBP) ≥90 mmHg or on treatment in new and SBP/DBP ≥140/≥90 mmHg or on treatment in JNC-7 (old) guidelines. The Chi-Square test was used to compare the association between categorical variables.Results: There were 565,813 and 1,607 eligible participants in NFHS-4 (India) and NHANES (the United States), respectively. Mean age was comparable (31.9±9.0 vs. 33.5±9.4 years, p<0.001). Prevalence of hypertension per old guidelines was higher in USA as compared to India (Figure Panel A). The new guidelines flipped the prevalence of hypertension such that it was significantly higher among women in India as compared to US overall and across all age groups (p<0.001 for all). The overall increase in prevalence among women in India and the United States was 153% (19% to 44%) and 39% (23% to 32%), respectively (Figure Panel B).Conclusions: There is a higher impact of new guidelines on the prevalence of hypertension among women in India, across all age groups as compared to the United States. Future studies will help understand the mechanisms, risk factors and impact of this change on treatment and health economics in India.