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The Burden of Modifiable Risk Factors in Newly Defined Categories of Blood Pressure

The 2017 American College of Cardiology/American Heart Association Guideline introduced new categories of high blood pressure. The vast majority of individuals in these newly defined categories are recommended for nonpharmacological intervention rather than antihypertensive therapy. This study sought to determine the burden of potentially modifiable risk factors of hypertension among untreated adults in the newly defined categories of blood pressure.


We analyzed data from the 1999-2014 National Health and Nutrition Examination Survey (N = 37,448). Potentially modifiable risk factors included abdominal obesity, high non-high-density lipoprotein (HDL) cholesterol, secondhand smoking, binge drinking, suboptimal physical activity, and low-fiber diet.


Although the prevalence of certain modifiable risk factors decreased during the study period, the prevalence of low fiber intake, suboptimal physical activity, abdominal obesity, and binge drinking remained high during the last combined survey cycle (2011-2014). Modifiable risk factors generally demonstrated dose–response relationships with high blood pressure categories. The most common type of risk factor clustering included low fiber intake, suboptimal physical activity, high non-HDL cholesterol, and abdominal obesity, with its prevalence increasing gradually from 9.5% (95% confidence interval, 8.8%-10.3%) in the normal blood pressure group to 16.5% (95% confidence interval, 14.8%-18.3%) in the stage 2 hypertension group (Ptrend < .001). The prevalence of 4 or more modifiable risk factors per participant increased stepwise, ranging from 28.5% in the normal blood pressure group to 48.0% in the stage 2 hypertension group (Ptrend < .001).


The burden of potentially modifiable risk factors for hypertension shows progressive increase along the blood pressure categories and represents an important target for nonpharmacologic intervention.

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-Anna Gu, MD, PhD, Yu Yue, PhD, Joohae Kim, PharmD Candidate, Edgar Argulian, MD, MPH

This article originally appeared in the November issue of The American Journal of Medicine.

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