Intracranial Atherosclerosis and Stage 1 Hypertension Defined by the 2017 ACC/AHA Guideline

Ki-Woong Nam, Hyung-Min Kwon, Han-Yeong Jeong, Jin-Ho Park, Hyuktae Kwon, Su-Min Jeong

Research output: Contribution to journalArticle


BACKGROUND: In 2017, the American College of Cardiology (ACC)/American Heart Association (AHA) released a new, stricter definition of stage 1 hypertension which was previously considered prehypertension. However, impacts of the novel stage 1 hypertension on deleterious target organ outcomes are still controversial. In this study, we evaluated the relationship between this newly defined stage 1 hypertension and the presence of intracranial atherosclerosis (ICAS) lesions in neurologically healthy participants.

METHODS: We assessed consecutive participants in routine health check-ups between January 2006 and December 2013. BP was classified according to the 2017 ACC/AHA hypertension guideline, and ICAS was defined as occlusion or ≥ 50% stenosis of intracranial vessels on flight magnetic resonance angiography.

RESULTS: Among 3,111 healthy participants (mean age: 56 years, sex: 54% men), 85 (3%) had ICAS lesions. In multivariate analysis, stage 1 hypertension (adjusted odds ratio: 2.46, 95% confidence interval: 1.10-5.51, P = 0.029) remained an independent predictor of ICAS after adjustment for confounders. Stage 2 hypertension showed a higher odds ratio and a lower P-value, indicating a dose-response effect. Age and HbA1c level were also significantly associated with ICAS, independent of the BP categories. The ICAS lesion burden showed a dose-response effect across the BP categories (P for trend < 0.001), while ICAS lesion location did not (P for trend = 0.699).

CONCLUSIONS: We demonstrated that stage 1 hypertension, defined according to the 2017 ACC/AHA guideline, was associated with a higher prevalence and burden of ICAS lesions in a neurologically healthy population.

Original languageEnglish
Pages (from-to)92-98
Number of pages7
JournalAmerican Journal of Hypertension
Issue number1
Early online date21 Aug 2019
StatePublished - 1 Jan 2020


  • Atherosclerosis
  • Blood pressure
  • Cerebrovascular disease
  • Hypertension
  • Prehypertension

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