Implications of the New American College of Cardiology Guidelines for Hypertension Prevalence in India

In India, ischemic heart disease is the leading cause of death and premature death, and high blood pressure (BP) is the fourth leading risk factor of death and disability.1 In a recent study in JAMA Internal Medicine, Geldsetzer et al2 reported the first national prevalence rate of hypertension in India to be 25%, based on a systolic BP of 140 mm Hg or higher or a diastolic BP of 90 mm Hg or higher, as defined in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines (JNC7).3 In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Clinical Practice Guidelines reduced the systolic BP and diastolic BP threshold for stage 1 hypertension to 130/80 mm Hg and recommended the initiation of BP-lowering medication if the patient’s 10-year risk for cardiovascular disease (CVD) is 10% or greater or if the patient has known clinical CVD, diabetes, or chronic kidney disease.4 The objective of the present study was to estimate the difference in hypertension prevalence in India depending on whether the JNC7 or the ACC/AHA guidelines were applied.