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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)

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 mellitusb 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)

Chronic kidney diseasec 1,537/37,912 (4.1) 1,136 (8.5) 401/24,566 (1.6)

Glomerular filtration rate,

mL/min/1.73 m287 (76-98) 81 (71-91) 90 (80-101)

Current smoking 7,824/37,886 (20.7) 2,271 (17.0) 5,553/24,540 (22.6)

Hyperlipidemiad 4,668/36,346 (12.8) 2,611 (19.6) 2,057/23,000 (8.9)

Total cholesterol, mg/dl 185 (163-210) 191 (168-216) 183 (161-207)

Obesity

BMI ≥ 25, no. (%)e 12,175/39,058 (31.2) 5,732 (42.9) 6,443/25,712 (25.1)

BMI ≥ 30, no. (%) 1,509/39,058 (3.9) 792 (5.9) 717/25,712 (2.8)

Prevalent cardiovascular diseasef 1,653/38,560 (4.3) 1,198 (9.0) 455/25,214 (1.8)

Receiving antihypertensive agents 7,389/38,560 (19.2) 7,373 (55.2) 16/25,214 (0.1)

Framingham risk score

<10% 27,365/36,330 (75.3) 7,272 (54.5) 20,093/22,984 (87.4)

10-20% 6,385/36,330(17.6) 3,977 (29.8) 2,408/22,984 (10.5)

>20% 2,580/36,330 (7.1) 2,097 (15.7) 483/22,984 (2.1)

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

< 60 years 5,233 (39.2) 539 (32.1) 2,960 (37.4) 1,734 (46.2) <0.001

≥ 60 years 8,113 (60.8) 1,138 (67.9) 4,954 (62.6) 2,021 (53.8) <0.001

Male sex 6,081 (45.6) 728 (43.4) 3,667 (46.3) 1,686 (44.9) 0.06

Systolic blood pressure, mm Hg 135 (129-144) 113 (108-116) 133 (130-138) 151 (144-160) <0.001

Diastolic blood pressure, mm Hg 82 (74-90) 71 (66-77) 81 (75-89) 90 (80-97) <0.001

Heart rate, beats/min 56 (53-58) 56 (52-58) 56 (53-58) 56 (54-64) 0.02

Diabetes mellitusc 2,615 (19.6) 449 (26.8) 1,230 (15.5) 936 (24.9) <0.001

Fasting glucose level, mg/dl 98 (91-110) 99 (91-114) 97 (91-108) 100 (92-113) <0.001

Chronic kidney diseased 1,136 (8.5) 221 (13.2) 490 (6.2) 425 (11.3) <0.001

Glomerular filtration rate,

mL/min/1.73 m2

81 (71-91) 77 (68-87) 82 (71-92) 81 (70-92) <0.001

Current smoking 2,271 (17.0) 289 (17.2) 1,322 (16.7) 660 (17.6) 0.49

Hyperlipidemiae 2,611 (19.6) 402 (24.0) 1,486 (18.8) 723 (19.3) <0.001

Total cholesterol, mg/dl 191 (168-216) 183 (159-206) 191 (16-216) 195 (171-220) <0.001

Obesity

BMI ≥ 25, no. (%)f 5,732 (42.9) 764 (45.6) 3,312 (41.8) 1,656 (44.1) 0.005

BMI ≥ 30, no. (%) 792 (5.9) 101 (6.0) 455 (5.7) 236 (6.3) 0.51

Prevalent cardiovascular diseaseg 1,198 (9.0) 239 (14.3) 647 (8.2) 312 (8.3) <0.001

Receiving antihypertensive agents 7,373 (55.2) 1,669 (99.5) 4,071 (51.4) 1,633 (43.5) <0.001

Framingham risk score <0.001

<10% 7,272 (54.5) 1,163 (69.4) 4,334 (54.8) 1,775 (47.3)

10-20% 3,977 (29.8) 412 (24.6) 2,397 (30.3) 1,168 (31.1)

>20% 2,097 (15.7) 102 (6.1) 1,183 (14.9) 812 (21.6)

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.

All Adults with

Hypertension

(N=67,965) Status of BP Control Levelsa

P for

Trend

Variable

Below SPRINT BP

Goal

(N=5,639)

Above SPRINT BP

Goal, but below JNC 7

BP Goal

(N=37,494)

Above JNC 7

BP Goal

(N=24,832)

Major cardiovascular eventsb

No. of events 1,158 99 484 575

Rate (95% CI)c 2.60 (2.45-2.75) 2.53 (2.08-3.08) 2.29 (2.10-2.51) 3.08 (2.84-3.34)

Hazard ratio

Age- and sex-adjusted Referent 1.00 (0.80-1.24) 1.34 (1.08-1.66) <0.001

Multivariable adjustedd Referent 1.14 (0.92-1.43) 1.36 (1.09-1.69) <0.001

Death from cardiovascular causes

No. of events 298 25 120 153

Rate (95% CI) 0.67 (0.60-0.75) 0.58 (0.39-0.86) 0.57 (0.47-0.68) 0.82 (0.70-0.96)

Hazard ratio

Age- and sex-adjusted Referent 1.02 (0.66-1.57) 1.34 (0.88-2.05) 0.03

Multivariable adjusted Referent 1.28 (0.82-1.99) 1.47 (0.96-2.26) <0.001

Myocardial infarction

No. of events 513 42 202 269

Rate (95% CI) 1.15 (1.06-1.26) 1.19 (0.88-1.62) 0.95 (0.82-1.09) 1.43 (1.27-1.61)

Hazard ratio


Multivariable adjusted Referent 1.13 (0.81-1.59) 1.46 (1.05-2.03) 0.003

Stroke

No. of events 664 58 287 319

Rate (95% CI) 1.49 (1.38-1.61) 1.36 (1.05-1.76) 1.37 (1.22-1.54) 1.71 (1.53-1.91)

Hazard ratio



All-cause mortality

No. of events 1,982 245 791 946

Rate (95% CI) 4.45 (4.25-4.65) 5.79 (5.11-6.57) 3.94 (3.67-4.22) 4.77 (4.48-5.09)

7

Hazard ratio



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.

8


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

Variable

Below SPRINT BP

Goal

(N=5,046)

Above SPRINT BP


Guideline BP Goal

(N=40,118)

Above 2014

Guideline BP Goal

(N=16,058)

Major cardiovascular eventsb

No. of events 890 74 507 309

Rate (95% CI)c 2.07 (1.71-2.43) 2.01 (0.77-3.24) 1.85 (1.43-2.27) 2.68 (1.88-3.48)

Hazard ratio


Multivariable adjustedd Referent 1.14 (0.89-1.46) 1.56 (1.20-2.03) <0.001


No. of events 155 12 89 54

Rate (95% CI) 0.36 (0.21-0.51) 0.29 (-0.18-0.77) 0.33 (0.15-0.51) 0.46 (0.13-0.79)

Hazard ratio




No. of events 417 31 242 144

Rate (95% CI) 0.97 (0.72-1.22) 0.95 (0.10-1.80) 0.88 (0.59-1.17) 1.22 (0.68-1.76)

Hazard ratio



Stroke

No. of events 486 44 271 171

Rate (95% CI) 1.13 (0.86-1.40) 1.09 (0.18-1.99) 0.99 (0.68-1.30) 1.52 (0.91-2.12)

Hazard ratio



All-cause mortality

No. of events 1054 126 611 317

10

Rate (95% CI) 2.45 (2.06-2.84) 3.07 (1.55-4.60) 2.23 (1.77-2.69) 2.77 (1.95-3.58)

Hazard ratio



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


antihypertensive treatment, use or nonuse of aspirin, use or nonuse of statin therapy, Charlson comorbidity index, and systolic BP as

time-varying covariate.

11


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

Variable

Below SPRINT BP

Goal

(N=4,287)

Above SPRINT BP


Guideline BP Goal

(N=20,384)

Above 2014

Guideline BP Goal

(N=18,110)

Major cardiovascular eventsc

No. of events 920 89 426 405

Rate (95% CI)d 3.15 (2.95-3.35) 3.05 (2.48-3.76) 2.77 (2.52-3.05) 3.66 (3.32-4.03)

Hazard ratio


Multivariable adjustede Referent 0.98 (0.78-1.23) 1.28 (1.02-1.61) <0.001


No. of events 258 25 126 107

Rate (95% CI) 0.88 (0.78-1.00) 0.86 (0.58-1.27) 0.82 (0.69-0.98) 0.97 (0.80-1.17)

Hazard ratio




No. of events 402 36 184 182

Rate (95% CI) 1.37 (1.25-1.52) 1.31 (0.94-1.81) 1.21 (1.05-1.40) 1.61 (1.40-1.87)

Hazard ratio



Stroke

No. of events 535 54 249 232

Rate (95% CI) 1.83 (1.68-1.99) 1.78 (1.36-2.33) 1.60 (1.42-1.81) 2.14 (1.88-2.43)

Hazard ratio



All-cause mortality

No. of events 1,579 201 780 598

13

Rate (95% CI) 5.40 (5.14-5.67) 6.79 (5.92-7.80) 4.93 (4.60-5.29) 5.73 (5.29-6.21)

Hazard ratio



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


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.

21

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

Heart Study. BMJ Open 2014;4:e005025.

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