Epidemiology of Arterial Hypertension in Russian Federation – Importance of Choice of Criteria of Diagnosis

Purpose. Assessment of prevalence of arterial hypertension (AH), need for prescription of antihypertensive therapy (AHT), and efficacy of AHT in Russian population in accordance with novel guideline of the American College of Cardiology/American Heart Association (“American recommendations”) on diagnosis and treatment of AH (2017).

Materials and methods. Epidemiological study ESSE-RF (ЭССЕ-РФ) was carried out in 12 regions of Russian Federation (RF) with different climatic-geographic characteristics. Number of examined residents of RF aged 25–65 years was 20 652. The sample was stratified by  gender and age. Examination included anthropometry, laboratory tests, blood pressure (BP) measurement with the OMRON tonometer. The SCORE scale was used for evaluation of risk of development of cardiovascular diseases (CVD). In  American recommendations AH was defined as  follows: 1-st degree  – systolic BP (SBP) 130–139  and/or diastolic BP (DBP) 80–89 mm Hg, 2-nd degree – BP ≥140/90 mm Hg and/or presence of AHT. In recommendations of the European Society of Cardiology (2013, 2018) (“European recommendations”) AH was defined as BP ≥140/90 mm Hg and/or presence of AHT.

Results. We analyzed data of examination of  20 607  participants – 7806 men (37.9%) and 12 801  women (62.1%). According to  European recommendations AH was diagnosed in 10 347  persons (50.2%)  – 3987 men (51.1%) men and 6 360 women (49.7%). According to American recommendations AH was registered in 14 853 persons (72.1%) – 6 059 men (77.6%) and 8 794 women (68.7%). AHT received 6324 persons (61.1% of those with AH); according to American recommendations, the onset of AHT was indicated to additional 620 persons with 1-st degree AH because of high CVD risk. Among all participants with AH (on and without AHT) strengthening of AHT for achievement of target BP level was required in 77.8 and 92.6% of patients according to European and American recommendations, respectively.

Conclusion. Application of novel criteria of AH diagnosis from 2017 ACC/AHA guideline to Russian population would increase prevalence of AH up to 72.1%. Onset of AHT would be indicated in 13.8% of patients with 1-st degree AH, while in 93% of patients receiving AHT its strengthening would be required.

1. Zhou B, Bentham J, Di Cesare M, Bixby H, Danaei G, Cowan MJ et al. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19•1 million participants. The Lancet. 2017;389(10064):37– 55. DOI:10.1016/S0140-6736(16)31919-5

2. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13. PMID:12493255

3. Huang Y, Wang S, Cai X, Mai W, Hu Y, Tang H et al. Prehypertension and incidence of cardiovascular disease: a meta-analysis. BMC Medicine. 2013;11(1):177. DOI:10.1186/1741-7015-11-177

4. Huang Y, Cai X, Li Y, Su L, Mai W, Wang S et al. Prehypertension and the risk of stroke: A meta-analysis. Neurology. 2014;82(13):1153– 61. DOI:10.1212/WNL.0000000000000268

5. Huang Y, Cai X, Zhang J, Mai W, Wang S, Hu Y et al. Prehypertension and Incidence of ESRD: A Systematic Review and Meta-analysis. American Journal of Kidney Diseases. 2014;63(1):76–83. DOI:10.1053/j.ajkd.2013.07.024

6. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C 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: Executive Summary: A Report ofthe American Collegeof Cardiology/American Heart AssociationTask Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269–324. DOI:10.1161/HYP.0000000000000066

7. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018;39(33):3021–104. DOI:10.1093/eurheartj/ehy339

8. Kobalava Zh. D., Konradi A. O., Nedogoda S. V., Arutyunov G. P., Baranova E. I., Barbarash O. L. et al. Russian Society of Cardiology position paper on 2018 Guidelines of the European Society of Cardiology/European Society of Arterial Hypertension for the management of arterial hypertension. Russian Journal of Cardiology. 2018;23(12):131–42. [Russian] DOI: 10.15829/1560-4071-2018-12-131-142

9. Boytsov S. A., Chazov E. I., Shlyakhto E. V., Shal’nova S. A., Konradi A. O., Karpov Yu. A. et al. Scientific-Organizing Committee of the ESSE-RF Project. Epidemiology of cardiovascular diseases in different regions of Russia (ESSE-RF). The rationale for and design of the study. Preventive medicine. 2013;16(6):25–34. [Russian]

10. Chazova I. E., Oshepkova E. V., Zhernakova Yu. V., Karpov Yu. A., Arkhipov M. V., Barbarash O. L. et al. Clinical guidelines Diagnostics and treatment of arterial hypertension. Kardiologicheskij Vestnik. 2015;10(1):3–30. [Russian]

11. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003;24(11):987–1003. PMID:12788299

12. Bastuji-Garin S, Deverly A, Moyse D, Castaigne A, Mancia G, de Leeuw PW et al. The Framingham prediction rule is not valid in a European population of treated hypertensive patients. J Hypertens. 2002;20(10):1973–80. PMID:12359975

13. Erina A. M., Rotar O. P., Orlov A. V., Solntsev V. N., Shalnova S. A., Deev A. D. et al. Prehypertension and cardiometabolic risk factors (data of the ESSE-RF study). Arterial Hypertension. 2017;23(3):243–52. [Russian] DOI: 10.18705/1607-419X-2017-23-3-243-252

14. The SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. New England Journal of Medicine. 2015;373(22):2103–16. DOI: 10.1056/NEJMoa1511939

15. Bress AP, Kramer H, Khatib R, Beddhu S, Cheung AK, Hess R et al. Potential Deaths Averted and Serious Adverse Events Incurred From Adoption of the SPRINT (Systolic Blood Pressure Intervention Trial) Intensive Blood Pressure Regimen in the United States: Projections From NHANES (National Health and Nutrition Examination Survey). Circulation. 2017;135(17):1617–28. DOI: 10.1161/CIRCULATIONAHA.116.025322

16. Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT et al. Potential US Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline. Circulation. 2018;137(2):109–18. DOI:10.1161/CIRCULATIONAHA.117.032582

17. Boytsov S. A., Balanova Yu. A., Shalnova S. A., Deev A. D., Artamonova G. V., Gatagonova T. M. et al. Arterial hypertension among persons aged 25-64: prevalence, awareness, treatment and control. By the data from ECCD. Cardiovascular Therapy and Prevention. 2014;13(4):4–14. [Russian] DOI:10.15829/1728-8800-2014-4-4-14

18. Messerli FH, Rimoldi SF, Bangalore S. Changing definition of hypertension in guidelines: how innocent a number game? European Heart Journal. 2018;39(24):2241–2. DOI: 10.1093/eurheartj/ehx806

19. Rotar O. P., Tolkunova K. M., Mevsha O. V., Nedbaikin A. M., Kochergina A. M., Chernova A. A. et al. Screening blood pressure measurement in the Russian population (the results of the МММ17 activity). Arterial Hypertension. 2018;24(4):448–58. [Russian] DOI:10.18705/1607-419X-2018-24-4-448-458

20. Stewart IM. Headache and hypertension. Lancet. 1953;1(6774): 1261–6. PMID:13053745

21. Rostrup M, Mundal HH, Westheim A, Eide I. Awareness of high blood pressure increases arterial plasma catecholamines, platelet noradrenaline and adrenergic responses to mental stress. J Hypertens. 1991;9(2):159–66. PMID:1849532

22. de la Sierra A, Banegas JR, Vinyoles E, Segura J, Gorostidi M, de la Cruz JJ et al. Prevalence of Masked Hypertension in Untreated and Treated Patients With Office Blood Pressure Below 130/80 mm Hg. Circulation. 2018;137(24):2651–3. DOI:10.1161/CIRCULATIONAHA.118.034619

23. Mehlum MH, Liestøl K, Kjeldsen SE, Julius S, Hua TA, Rothwell PM et al. Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks. European Heart Journal. 2018;39(24):2243–51. DOI:10.1093/eurheartj/ehx760

24. Federal State Statistics Service [Internet]. 2018 [cited 2019]. [Russian] http://www.gks.ru/wps/wcm/connect/rosstat_main/rosstat/ru/rates/bfd61f804a41fabfbdc9b-f78e6889fb6

25. Ioannidis JPA. Diagnosis and Treatment of Hypertension in the 2017 ACC/AHA Guidelines and in the Real World. JAMA. 2018;319(2):115–6. DOI:10.1001/jama.2017.19672