Research Paper Volume 13, Issue 7 pp 10075—10086

The 2017 ACC/AHA stage 1 hypertension is associated with arterial stiffness: a prospective analysis

Shanshan Liu1,2, *, , Shujing Wu1,2, *, , Jingya Niu1,2, , Ruizhi Zheng1,2, , Lizhan Bie1,2, , Zhuojun Xin1,2, , Shuangyuan Wang1,2, , Hong Lin1,2, , Zhiyun Zhao1,2, , Mian Li1,2, , Tiange Wang1,2, , Min Xu1,2, , Jieli Lu1,2, , Yuhong Chen1,2, , Yiping Xu3, , Yufang Bi1,2, , Weiqing Wang1,2, , Guang Ning1,2, , Yu Xu1,2, ,

  • 1 Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
  • 2 Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
  • 3 Clinical Trials Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
* Equal contribution

Received: November 13, 2020       Accepted: February 3, 2021       Published: March 26, 2021
How to Cite

Copyright: © 2021 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Objective: To examine the association between stage 1 hypertension defined by the 2017 American College of Cardiology and American Heart Association (ACC/AHA) guideline and risk of developing arterial stiffness.

Methods: During 2010-2015, 4595 adults aged ≥40 years without cardiovascular disease were followed up for a median of 4.3 years. BP levels at baseline were categorized into normal, elevated, stage 1 hypertension, and stage 2 hypertension. The development of arterial stiffness was defined as a normal brachial-ankle pulse wave velocity (ba-PWV) at baseline and an increased ba-PWV at follow-up.

Results: Compared with participants with normal BP, participants with stage 1 hypertension had a 1.48-fold increased risk of developing arterial stiffness [odds ratio (OR) =2.48; 95% confidence interval (CI) =1.59-3.85] after adjustment for cardiovascular risk factors. The association was more evident in adults aged 40-59 years (OR =4.08; 95% CI =2.06-8.08) than that in those aged ≥60 years (OR =1.47; 95% CI =0.81-2.67). A systolic BP 130~139 mmHg was significantly associated with arterial stiffness independent of diastolic BP (OR =2.90; 95% CI =1.86-4.52). Stage 1 hypertension either at baseline or at follow-up was associated with increased risks compared with normal BP at both baseline and follow-up.

Conclusions: The 2017 ACC/AHA stage 1 hypertension was significantly associated with higher risks of arterial stiffness.


BP: blood pressure; CVD: cardiovascular disease; ACC/AHA: American College of Cardiology and American Heart Association; ESC/ESH: European Society of Cardiology/European Society of Hypertension; ISH: International Society of Hypertension; PWV: pulse wave velocity; ba-PWV: brachial-ankle pulse wave velocity; BMI: body mass: index; FPG: fasting plasma glucose; LDL cholesterol: low-density lipoprotein cholesterol; ACR: albumin-to-creatinine ratio; HDL cholesterol: high-density lipoprotein cholesterol; eGFR: estimated glomerular filtration rate; OR: odds ratio; CI: confidence interval; IPAQ: Physical Activity Questionnaire; METs-min/week: metabolic equivalents-minute per week; CKD-EPI equation: Chronic Kidney Disease Epidemiology Collaboration equation.