Online Appendix Online Table 1. Baseline Characteristics of All KNHANES Participants and Those Included in Study Population vs. Those Excluded. a Variable All KNHANES Participants (N=41,321) Included Study Participants (N=13,346) Excluded Participants (N=27,975) Age Median (IQR), y 49 (36-63) 63 (53-72) 41 (32-53) < 60 years 28,525 (69.0) 5,233 (39.2) 23,292 (83.3) ≥ 60 years 12,796 (31.0) 8,113 (60.8) 4,683 (16.7) Male sex 17,908 (43.3) 6,081 (45.6) 11,827 (42.3) Systolic blood pressure, mm Hg 117 (106-130) 135 (129-144) 110 (102-118) Diastolic blood pressure, mm Hg 75 (69-82) 82 (74-90) 72 (68-79) Heart rate, beats/min 56 (54-58) 56 (53-58) 56 (54-58) Diabetes mellitus b 3,911/36,594 (10.7) 2,615 (19.6) 1,296/23,248 (5.6) Fasting glucose level, mg/dl 93 (87-101) 98 (91-110) 91 (86-97)
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Online Appendix
Online Table 1. Baseline Characteristics of All KNHANES Participants and Those Included in
Study Population vs. Those Excluded.a
Variable
All KNHANES
Participants
(N=41,321)
Included Study
Participants
(N=13,346)
Excluded
Participants
(N=27,975)
Age
Median (IQR), y 49 (36-63) 63 (53-72) 41 (32-53)
< 60 years 28,525 (69.0) 5,233 (39.2) 23,292 (83.3)
≥ 60 years 12,796 (31.0) 8,113 (60.8) 4,683 (16.7)
Abbreviations: BMI, body mass index; KNHANES, Korea National Health and Nutrition
Examination Surveys.a Data are expressed as median (interquartile range) or number (%).b Diabetes mellitus was defined as a fasting glucose level higher than 126 mg per deciliter or
current use of antidiabetic drugs or by physician’s diagnosis. c Chronic kidney disease was defined as an estimated glomerular filtration rate < 60 mL/min/1.73
m2
d Hyperlipidemia was defined as a total cholesterol level of 240 mg/dl or more or receiving statin
therapy.e The BMI is the weight in kilograms divided by the square of the height in meters.f Cardiovascular disease includes coronary heart disease, angina, and stroke.
2
Online Table 2. Comparison of Characteristics and Risk Factor Profiles of the KNAHNES Sample with Hypertension and Those
Who Meet or Not Meet BP Goals According to the SPRINT Criteria and the 2014 BP Guideline.a
Variable
All Adults with
Hypertension
(N=13,346) Status of BP Controlb P Value
Below SPRINT BP
Goal
(N=1,677)
Above SPRINT BP
Goal, but below 2014
Guideline BP Goal
(N=7,914)
Above 2014
Guideline BP Goal
(N=3,755)
Age
Median (IQR), y 63 (53-72) 65 (57-73) 63 (53-72) 62 (52-72) <0.001
Abbreviations: BMI, body mass index; BP, blood pressure; CKD, chronic kidney disease; KNHANES, Korea National Health and
Nutrition Examination Surveys.
4
a Data are expressed as median (interquartile range) or number (%).b BP target used in the SPRINT criteria was defined as systolic BP <120 mm Hg (1) and those used in the 2014 hypertension
guidelines were defined as BP <140/90 mm Hg in ages 18-59 years without CKD or diabetes, BP <150/90 mm Hg in ages ≥60 years
without CKD or diabetes, BP <140/90 mm Hg in CKD, and BP <140/90 mm Hg in diabetes (2).c Diabetes mellitus was defined as a fasting glucose level higher than 126 mg per deciliter or current use of antidiabetic drugs or by
physician’s diagnosis. d Chronic kidney disease was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2
e Hyperlipidemia was defined as a total cholesterol level of 240 mg/dl or more or receiving statin therapy.f The BMI is the weight in kilograms divided by the square of the height in meters.g Cardiovascular disease includes coronary heart disease, angina, and stroke.
5
Online Table 3. Standardized Event Rates and Hazard Ratios for Adverse Cardiovascular Events According to Status of BP Control
Based On the SPRINT and JNC 7 Guideline Among Adults with Hypertension in the NHIS Health Examinee Cohort.
Abbreviations: BMI, body mass index; BP, blood pressure; CI confidence interval; CKD, chronic kidney disease; JNC, Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; KNHANES, Korea National Health and
Nutrition Examination Surveys; NHIS, National Health Insurance Service; SPRINT, Systolic Blood Pressure Intervention Trial. a BP target used in the SPRINT criteria was defined as systolic BP <120 mm Hg (1) and those used in the JNC 7 hypertension
guidelines were defined as BP <140/90 mm Hg in any ages (18-59 years and ≥60 years) without CKD or diabetes, BP <130/80 mm
Hg in CKD, and BP <130/80 mm Hg in diabetes (3).b Major cardiovascular events included nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. Each
component of myocardial infarction and strokes included fatal and nonfatal events.c The event rates were standardized for age and sex. The rates are per 1000 person-years. d For the multivariable-adjusted hazard ratios, data were adjusted for age at baseline, sex, presence or absence of diabetes, presence or
absence of chronic kidney disease, smoking status, presence or absence of hyperlipidemia, body-mass index, use or nonuse of
antihypertensive treatment, use or nonuse of aspirin, use or nonuse of statin therapy, and Charlson comorbidity index.
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Online Table 4. Standardized Event Rates and Hazard Ratios for Adverse Cardiovascular Events According to Status of BP Control
Based On the SPRINT and 2014 Hypertension Guideline Among Adults with Hypertension in the NHIS Health Examinee Cohort By
the Time-Updated Cox Models, Adjusting Systolic Blood Pressure as a Time-Varying Covariate.
All Adults with
Hypertension
(N=61,222) Status of BP Control Levelsa P for Trend
Abbreviations: BMI, body mass index; BP, blood pressure; CI confidence interval; CKD, chronic kidney disease; JNC, Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; KNHANES, Korea National Health and
Nutrition Examination Surveys; NHIS, National Health Insurance Service; SPRINT, Systolic Blood Pressure Intervention Trial. a BP target used in the SPRINT criteria was defined as systolic BP <120 mm Hg (1) and those used in the 2014 hypertension guideline
were defined as BP <140/90 mm Hg in ages 18-59 years without CKD or diabetes, BP <150/90 mm Hg in ages ≥60 years without
CKD or diabetes, BP <140/90 mm Hg in CKD, and BP <140/90 mm Hg in diabetes (2).b Major cardiovascular events included nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. Each
component of myocardial infarction and strokes included fatal and nonfatal events.c The event rates were standardized for age and sex. The rates are per 1000 person-years. d For the multivariable-adjusted hazard ratios, data were adjusted for age at baseline, sex, presence or absence of diabetes, presence or
absence of chronic kidney disease, smoking status, presence or absence of hyperlipidemia, body-mass index, use or nonuse of
antihypertensive treatment, use or nonuse of aspirin, use or nonuse of statin therapy, Charlson comorbidity index, and systolic BP as
time-varying covariate.
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Online Table 5. Standardized Event Rates and Hazard Ratios for Adverse Cardiovascular Events According to Status of BP Control
Based On the SPRINT and 2014 Hypertension Guideline Among Adults with Hypertension in the NHIS Health Examinee Cohort
Adopting Alternative Hypertension Definition.a
All Adults with
Hypertension
(N=42,781) Status of BP Control Levelsb P for Trend
Abbreviations: BMI, body mass index; BP, blood pressure; CI confidence interval; CKD, chronic kidney disease; KNHANES, Korea
National Health and Nutrition Examination Surveys; NHIS, National Health Insurance Service; SPRINT, Systolic Blood Pressure
Intervention Trial.a In this analysis, hypertension was alternatively defined as physician-diagnosed, patient-reported BP treatment, or a systolic BP ≥140
mm Hg or a diastolic BP ≥90 mm Hg.b BP target used in the SPRINT criteria was defined as systolic BP <120 mm Hg (1) and those used in the 2014 hypertension guideline
were defined as BP <140/90 mm Hg in ages 18-59 years without CKD or diabetes, BP <150/90 mm Hg in ages ≥60 years without
CKD or diabetes, BP <140/90 mm Hg in CKD, and BP <140/90 mm Hg in diabetes (2).c Major cardiovascular events included nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. Each
component of myocardial infarction and strokes included fatal and nonfatal events.d The event rates were standardized for age and sex. The rates are per 1000 person-years. e For the multivariable-adjusted hazard ratios, data were adjusted for age at baseline, sex, presence or absence of diabetes, presence or
absence of chronic kidney disease, smoking status, presence or absence of hyperlipidemia, body-mass index, use or nonuse of
antihypertensive treatment, use or nonuse of aspirin, use or nonuse of statin therapy, and Charlson comorbidity index.
14
Online Figure 1. Participant Inclusion and Exclusion Criteria for the KNHANES Study and the NHIS Health Examinee Cohort
Study.
Online Figure 2. Estimated Percentages of Adults with Hypertension Who Would Meet or Not Meet Blood-Pressure Targets Under
the 2014 Guideline and the SPRINT Criteria, According to Major Subgroups.
Online Figure 3. Ten-Year Predicted Risk of Cardiovascular Events According to Status of
Blood-Pressure Control Under the 2014 Hypertension Guideline and the SPRINT Criteria, as
Measured by the Korean CHD risk score (4).
The mean estimate of the 10-year risk of cardiovascular events on the basis of the Korean CHD
risk score was lowest in adults who met the SPRINT goals (1.46; 95% confidence interval [CI],
1.38 to 1.54), intermediate in those who met the 2014 guideline goals, but not the SPRINT goals
(1.67; 95% CI, 1.63 to 1.71), and highest in those who did not meet the 2014 guideline goals
(2.36; 95% CI, 2.26 to 2.46) (P<0.001).
Online Figure 4. Estimated Percentages of Adults with Hypertension Who Would Meet or Not
Meet Blood-Pressure Targets Under the JNC 7 Guideline and the SPRINT Criteria.
Percentages were weighted on the basis of the KNHANES results. Hypertension was defined as
physician-diagnosed, patient-reported BP treatment, or systolic BP of 130 mm Hg or higher. The
BP target used in the SPRINT criteria was defined as systolic BP <120 mm Hg and those used in
the JNC 7 hypertension guideline were defined as BP <140/90 mm Hg in any ages (18-59 years
and ≥60 years) without CKD or diabetes, BP <130/80 mm Hg in CKD, and BP <130/80 mm Hg
in diabetes.
Online Figure 5. Ten-Year Predicted Risk of Cardiovascular Events According to Status of
Blood-Pressure Control Under the JNC 7 Guideline and the SPRINT Criteria, as Measured by
the Framingham Risk Score.
The mean estimate of the 10-year risk of cardiovascular events on the basis of the Framingham
risk score was lowest in adults who met the SPRINT goals (6.43; 95% confidence interval [CI],
6.10 to 6.76), intermediate in those who met the JNC 7 guideline goals, but not the SPRINT
goals (7.54; 95% CI, 7.30 to 7.78), and highest in those who did not meet the JNC 7 guideline
goals (10.80; 95% CI, 10.55 to 11.05) (P<0.001).
Online Figure 6. Hazard Ratios for Major Cardiovascular Events and Each Component According to Status of Blood-Pressure
Control the JNC 7 Guideline and the SPRINT Criteria.
Major cardiovascular events included nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. Each
component of myocardial infarction or stroke included fatal and nonfatal events. Increasing levels of BP control status were classified
according to the SPRINT and the JNC 7 criteria; below SPRINT BP goals vs. above SPRINT goals, but below JNC 7 BP goals vs.
above JNC 7 BP goals. All estimates were adjusted for age, sex, presence or absence of diabetes, presence or absence of CKD,
smoking status, presence or absence of hyperlipidemia, body-mass index, use or nonuse of antihypertensive treatment, use or nonuse
of aspirin, use or nonuse of statin therapy, and Charlson comorbidity index. The bars represent 95% confidence intervals.
Abbreviations: BP, blood pressure; CKD, chronic kidney disease; JNC, Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure; KNHANES, Korea National Health and Nutrition Examination Surveys; SPRINT,
Systolic Blood Pressure Intervention Trial.
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REFERENCES
1. The SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-
Pressure Control. N Engl J Med 2015;373:2103-16.
2. James PA, Oparil S, Carter BL et al. 2014 evidence-based guideline for the management
of high blood pressure in adults: report from the panel members appointed to the Eighth
Joint National Committee (JNC 8). JAMA 2014;311:507-20.
3. Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure:
the JNC 7 report. JAMA 2003;289:2560-72.
4. Jee SH, Jang Y, Oh DJ et al. A coronary heart disease prediction model: the Korean