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Agreement between 2017 ACC/AHA Hypertension Clinical Practice Guidelines and Seventh Report of the Joint National Committee Guidelines to Estimate Prevalence of Postmenopausal Hypertension in a Rural Area of Bangladesh: A Cross Sectional Study

1
Department of Noncommunicable Diseases, Bangladesh University of Health Sciences, 125/1 Darus Salam, Mirpur-1, Dhaka-1216, Bangladesh
2
Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences, 125/1 Darus Salam, Mirpur-1, Dhaka-1216, Bangladesh
*
Author to whom correspondence should be addressed.
Medicina 2019, 55(7), 315; https://doi.org/10.3390/medicina55070315
Received: 8 May 2019 / Revised: 24 June 2019 / Accepted: 25 June 2019 / Published: 26 June 2019
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Abstract

Background and objectives: Justification for application of 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines to detect hypertension (HTN) among Bangladeshi population is understudied. This prompted us to examine the level of agreement between 2017 ACC/AHA and Joint National Committee 7 (JNC 7) guidelines to detect postmenopausal HTN in a rural area of Bangladesh. Materials and Methods: This cross-sectional study recruited 265 postmenopausal women of 40–70 years of age who visited a rural primary health care centre of Bangladesh. HTN was diagnosed based on two definitions: the JNC 7 guidelines (SBP ≥ 140 or DBP ≥ 90 mmHg), and the 2017 ACC/AHA guidelines (SBP ≥ 130 mmHg, or DBP ≥ 80 mmHg). The prevalence of postmenopausal HTN, its sub-types and stages were reported and compared using frequency and percentage. Agreement was evaluated using Cohen’s Kappa (κ), Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) and First-order Agreement Coefficient (AC1). Results: The prevalence of postmenopausal HTN was 67.5% and 41.9% using 2017 ACC/AHA and JNC 7 guidelines respectively. Among the HTN sub-types and stages, the new 2017 ACC/AHA guideline classified higher proportion of respondents as having isolated systolic hypertension (ISH) (42.6%) and stage 2 HTN (35.8%) compared to JNC 7 (28.7% and 6.8% respectively). On the other hand, the JNC 7 guideline identified more respondents as pre-hypertensive (32.5%) when compared with the 2017 ACC/AHA guideline (3.8%). Between two guidelines, highest agreement was observed for ISH (86.03%) and those had pre-hypertension/elevated blood pressure (71.3%). Similarly, Landis & Koch’s approach detected highest agreement for ISH (κ = 0.74, substantial; PABAK = 0.76, substantial; AC1 = 0.84, excellent; p < 0.001) and pre-hypertension/elevated blood pressure (κ= 0.12, slight; PABAK = 0.42, moderate; AC1 = 0.83, excellent; p < 0.001). Conclusions: The 2017 ACC/AHA HTN guideline reported high agreement and detected more participants as hypertensive when compared with JNC 7 guideline for Bangladeshi postmenopausal women that demands further large-scale study in general population to clarify the current findings more precisely. View Full-Text
Keywords: postmenopausal women; hypertension; Bangladesh; American College of Cardiology/American Heart Association; Joint National Committee; agreement postmenopausal women; hypertension; Bangladesh; American College of Cardiology/American Heart Association; Joint National Committee; agreement
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Barua, L.; Faruque, M.; Banik, P.C.; Ali, L. Agreement between 2017 ACC/AHA Hypertension Clinical Practice Guidelines and Seventh Report of the Joint National Committee Guidelines to Estimate Prevalence of Postmenopausal Hypertension in a Rural Area of Bangladesh: A Cross Sectional Study. Medicina 2019, 55, 315.

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