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The newly released 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults provides comprehensive recommendations for the definition of hypertension, and systolic and diastolic blood pressure thresholds for initiation of antihypertensive medication.To determine the prevalence of hypertension and implications of recommendations for antihypertensive medication among middle-aged adults using criteria from the 2017 ACC/AHA and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) guidelines.We analyzed data of 252 participants restricted to 36–55 years of age pooling at Puskesmas Kecamatan Pasar Minggu who have completed standard interviewing procedures and examinations. For each participant, blood pressure measurements were taken following a standardized protocol. History of CVD was defined by self-report of prior diagnosis, and those without history of CVD, 10-year predicted risk was calculated.The overall crude prevalence of hypertension among middle-aged adults was 69.8% (95% confidence interval [CI] 63.8–75.4%) and 45.6% (95% CI 39.4–52%) according to the 2017 ACC/AHA and JNC 7 guidelines, respectively, and antihypertensive medication was recommended for 51.6 % (95% CI 45.2–57.9%) and 45.6 % (95% CI 39.4–52%) of the adults, respectively. Non-pharmacological intervention is suggested for 18.3% of middle-aged adults with hypertension who are not recommended antihypertensive medication according to the 2017 ACC/AHA guideline.The 2017 ACC/AHA guideline results in a substatial increase in the prevalence of hypertension compared with the JNC 7 guideline. However, the percentage of middle-aged adults recommended for antihypertensive medication only showed a modest increase.