Impact of the Discordance Between the American College of Cardiology/American Heart Association and American Diabetes Association Recommendations on Hypertension in Patients With Diabetes Mellitus in the United States
Hypertension is common in patients with diabetes mellitus,1,2 and coexistence of hypertension and diabetes mellitus significantly increases the risk of atherosclerotic cardiovascular disease (ASCVD).3 In 2017, the American College of Cardiology (ACC)/American Heart Association (AHA) published the new guideline for hypertension,2 and the American Diabetes Association (ADA) also published a position statement for hypertension and diabetes mellitus.4 The ACC/AHA recommended 130/80 mm Hg as the blood pressure (BP) threshold to define hypertension, whereas the ADA recommended 140/90 mm Hg. The authors of the ADA position statement emphasized the importance of an individualized approach to treat hypertension in patients with diabetes mellitus rather than changing the BP threshold.5 Because of the difference between the 2 recommendations and lack of quality evidence to determine a precise BP threshold/target in patients with diabetes mellitus,5 uncertainty still remains in this population. Because the clinical impact of this difference has never been studied, we investigated the prevalence and characteristics of diabetic patients with hypertension and discordant population in the United States according to the ACC/AHA and ADA recommendations.
We used data from the National Health and Nutrition Examination Survey (NHANES) 2005 to 2014, a cross-sectional survey representing the noninstitutionalized civilian population in the United States. It was conducted by the National Center for Health Statistics using a stratified, multistage probability sample design. Anonymized data are publicly available at the Centers for Disease Control and Prevention website and can be accessed at https://www.cdc.gov/nchs/nhanes/index.htm. Between 2005 and 2014, the overall response rates ranged from 68.5% to 77.5%. NHANES was approved by the National Center for Health Statistics Research Ethics Review Board. All participants provided written informed consent.
Among 28 461 adults aged ≥20 years from the NHANES 2005 to 2014, we firstly excluded participants without 3 BP measurements (n=3483) or data …