Potential Cardiovascular Disease Events Prevented with Adoption of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline
Potential Cardiovascular Disease Events Prevented with Adoption of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline
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DOI：
10.1161/circulationaha.118.035640
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发表时间：
2019-01-02
期刊：
影响因子：
37.8
通讯作者：
Moran, Andrew E.
中科院分区：
文献类型：
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作者：
Bress, Adam P.;Colantonio, Lisandro D.;Moran, Andrew E.
背景：与维持当前血压（BP）水平、实现2003年第七届全国联合委员会报告目标和实现2014年第八届全国联合委员会目标相比，在10年内，实现并维持2017年ACC/AHA指南目标可预防300万（UR， 110 - 510万）、50万（UR， 20 - 70万）和140万（UR， 60 - 200万）心血管疾病（CVD）事件。我们通过实现2017年ACC/AHA指南推荐的血压目标与(1)当前血压水平、(2)实现2003年第七届全国联合委员会报告的血压目标、(3)实现2014年第八届全国联合委员会小组成员报告的血压目标进行比较，估计了10年内美国成年高血压患者中预防心血管疾病事件和治疗相关严重不良事件的数量。方法：根据2017年ACC/AHA指南、2003年第七届全国联合委员会报告和2014年第八届全国联合委员会的降压药物治疗建议，对年龄bb0 = 45岁、有降压适应症的美国成年人进行分组。人口规模是根据2011年至2014年全国健康和营养检查调查估计的。致命性和非致命性CVD事件（中风、冠心病或心力衰竭）的发生率由REGARDS（中风的地理和种族差异的原因）研究估算，并对美国人口进行加权。通过降压试验的荟萃分析，获得了达到降压目标的心血管疾病风险降低和严重不良事件的风险。计算10年内预防的心血管疾病事件和治疗相关的非致命性严重不良事件。围绕主要数据输入的不确定性以不确定范围（UR）表示。结果：在10年内，与当前血压水平相比，实现并维持2017年ACC/AHA指南目标，实现2003年第七次全国联合委员会报告目标，或实现2014年第八次全国联合委员会目标，分别可以预防300万（UR， 110 - 510万），50万（UR， 20 - 70万）或140万（UR， 60 - 200万）心血管疾病事件。与目前的血压水平相比，实现并维持2017年的目标可以预防71.9 （UR, 26.6-122.3）例CVD事件。与当前血压水平相比，实现2017年指南血压目标也可能导致10年内近330万例严重不良事件（UR， 220 - 440万）。结论：与实现2003年第七次全国联合委员会报告或2014年第八次全国联合委员会血压目标相比，实现并维持2017年ACC/AHA血压目标可以预防更多的心血管事件，但也可能导致更严重的不良事件。
BACKGROUND: Over 10 years, achieving and maintaining 2017 ACC/AHA guideline goals could prevent 3.0 million (UR, 1.1-5.1 million), 0.5 million (UR, 0.2-0.7 million), and 1.4 million (UR, 0.6-2.0 million) cardiovascular disease (CVD) events compared with maintaining current blood pressure (BP) levels, achieving 2003 Seventh Joint National Committee Report goals, and achieving 2014 Eighth Joint National Committee goals, respectively. We estimated the number of cardiovascular disease events prevented and treatment-related serious adverse events incurred over 10 years among US adults with hypertension by achieving 2017 ACC/AHA guideline-recommended BP goals compared with (1) current BP levels, (2) achieving 2003 Seventh Joint National Committee Report BP goals, and (3) achieving 2014 Eighth Joint National Committee panel member report BP goals.METHODS: US adults aged >= 45 years with an indication for BP treatment were grouped according to recommendations for antihypertensive drug therapy in the 2017 ACC/AHA guideline, 2003 Seventh Joint National Committee Report, and 2014 Eighth Joint National Committee. Population sizes were estimated from the 2011 to 2014 National Health and Nutrition Examination Surveys. Rates for fatal and nonfatal CVD events (stroke, coronary heart disease, or heart failure) were estimated from the REGARDS (REasons for Geographic And Racial Differences in Stroke) study, weighted to the US population. CVD risk reductions with treatment to BP goals and risk for serious adverse events were obtained from meta-analyses of BP-lowering trials. CVD events prevented and treatment-related nonfatal serious adverse events over 10 years were calculated. Uncertainty surrounding main data inputs was expressed in uncertainty ranges (UR).RESULTS: Over ten years, achieving and maintaining 2017 ACC/AHA guideline goals compared with current BP levels, achieving 2003 Seventh Joint National Committee Report goals, or achieving 2014 Eighth Joint National Committee goals could prevent 3.0 million (UR, 1.1-5.1 million), 0.5 million (UR, 0.2-0.7 million), or 1.4 million (UR, 0.6-2.0 million) CVD events, respectively. Compared with current BP levels, achieving and maintaining 2017 goals could prevent 71.9 (UR, 26.6-122.3) CVD events per 1000 treated. Achieving 2017 guideline BP goals compared with current BP levels could also lead to nearly 3.3 million more serious adverse events over 10 years (UR, 2.2-4.4 million).CONCLUSIONS: Achieving and maintaining 2017 ACC/AHA BP goals could prevent a greater number of CVD events than achieving 2003 Seventh Joint National Committee Report or 2014 Eighth Joint National Committee BP goals but could also lead to more serious adverse events.