2017 年 ACC/AHA 高血压指南对美国人口的潜在影响。
Potential U.S. Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline.
机构信息
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Medicine, University of Virginia, Charlottesville, Virginia.
出版信息
J Am Coll Cardiol. 2018 Jan 16;71(2):109-118. doi: 10.1016/j.jacc.2017.10.073. Epub 2017 Nov 13.
BACKGROUND
The 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 recommendations for the definition of hypertension, systolic and diastolic blood pressure (BP) thresholds for initiation of antihypertensive medication, and BP target goals.
OBJECTIVES
This study sought to determine the prevalence of hypertension, implications of recommendations for antihypertensive medication, and prevalence of BP above the treatment goal among U.S. adults using criteria from the 2017 ACC/AHA guideline and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7).
METHODS
The authors analyzed data from the 2011 to 2014 National Health and Nutrition Examination Survey (N = 9,623). BP was measured 3 times following a standardized protocol and averaged. Results were weighted to produce U.S. population estimates.
RESULTS
According to the 2017 ACC/AHA and JNC7 guidelines, the crude prevalence of hypertension among U.S. adults was 45.6% (95% confidence interval [CI]: 43.6% to 47.6%) and 31.9% (95% CI: 30.1% to 33.7%), respectively, and antihypertensive medication was recommended for 36.2% (95% CI: 34.2% to 38.2%) and 34.3% (95% CI: 32.5% to 36.2%) of U.S. adults, respectively. Nonpharmacological intervention is advised for the 9.4% of U.S. adults with hypertension who are not recommended for antihypertensive medication according to the 2017 ACC/AHA guideline. Among U.S. adults taking antihypertensive medication, 53.4% (95% CI: 49.9% to 56.8%) and 39.0% (95% CI: 36.4% to 41.6%) had BP above the treatment goal according to the 2017 ACC/AHA and JNC7 guidelines, respectively.
CONCLUSIONS
Compared with the JNC7 guideline, the 2017 ACC/AHA guideline results in a substantial increase in the prevalence of hypertension, a small increase in the percentage of U.S. adults recommended for antihypertensive medication, and more intensive BP lowering for many adults taking antihypertensive medication.
背景
2017 年美国心脏病学会/美国心脏协会（ACC/AHA）高血压防治、检测、评估和管理指南为高血压的定义、开始降压药物治疗的收缩压和舒张压（BP）阈值以及 BP 目标提供了建议。
目的
本研究旨在使用 2017 年 ACC/AHA 指南和第七次联合国家委员会预防、检测、评估和治疗高血压报告（JNC7）的标准，确定美国成年人高血压的患病率、降压药物治疗建议的意义以及 BP 超过治疗目标的患病率。
方法
作者分析了 2011 年至 2014 年全国健康和营养调查（N=9623）的数据。BP 按照标准化方案测量 3 次，然后取平均值。结果进行加权，以产生美国人群的估计值。
结果
根据 2017 年 ACC/AHA 和 JNC7 指南，美国成年人高血压的粗患病率分别为 45.6%（95%置信区间[CI]：43.6%至 47.6%）和 31.9%（95% CI：30.1%至 33.7%），分别有 36.2%（95% CI：34.2%至 38.2%）和 34.3%（95% CI：32.5%至 36.2%）的美国成年人需要服用降压药物。根据 2017 年 ACC/AHA 指南，不建议对 9.4%的高血压患者使用降压药物，而建议对这些患者进行非药物干预。在服用降压药物的美国成年人中，根据 2017 年 ACC/AHA 指南，分别有 53.4%（95% CI：49.9%至 56.8%）和 39.0%（95% CI：36.4%至 41.6%）的患者 BP 超过治疗目标。
结论
与 JNC7 指南相比，2017 年 ACC/AHA 指南导致高血压的患病率显著增加，建议使用降压药物的美国成年人比例略有增加，许多服用降压药物的成年人的 BP 降低更为严格。
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