Changes in Hypertension Diagnostic Criteria Enhance Early Identification of at Risk College Students

Abstract

The revised (ACC/AHA) hypertension diagnostic criteria were intended to facilitate early identification and intervention among those with hypertension to improve patient health and lessen burden on the healthcare system. The purpose of this study was to examine fitness, anthropometric, and blood profile differences between college students who were or were not reclassified as hypertensive using the revised hypertension diagnostic criteria. Students completed an objective fitness assessment between September 2015 and April 2018. A total of 2724 students (71% men; 21 ± 1 yr) who were classified as prehypertensive under the old (JCN7) diagnostic criteria were included in the analyses. Men reclassified as having stage 1 hypertension using the ACC/AHA diagnostic criteria had a significantly higher body mass index (26.48 vs 25.66 kg·m⁻², P < 0.001), and body fat percentage (17.30% vs 16.15%, P < 0.001), abdominal girth (33.58 vs 32.81 in. P < 0.001), and lower predicted aerobic fitness (36.20 vs 37.63 mL·kg⁻¹⋅min⁻¹, P < 0.001) compared with those who remained classified as prehypertensive (i.e., elevated). Women reclassified as having stage 1 hypertension using the ACC/AHA diagnostic criteria had a significantly higher body mass index (25.28 vs 24.46 kg·m⁻², P = 0.015), and body fat percentage (28.63% vs 27.26%, P = 0.005), abdominal girth (30.10 vs 29.38 in. P = 0.011), and lower predicted aerobic fitness (34.07 vs 35.19 mL·kg⁻¹⋅min⁻¹, P = 0.031) compared with those who remained classified as prehypertensive. Blood profiles did not differ between those who were and those who were not reclassified as hypertensive for either sex. The odds of being reclassified varied from 3% to 7% based on the increase of a unit in each body composition variable and predicted aerobic fitness for both sexes. HDL was only predictive among men, and LDL was only predictive among women. The change in hypertension diagnostic criteria had the intended impact, as an increased number of college students with poorer fitness and less favorable anthropometric profiles were diagnosed as having hypertension.