Estimating the Association of the 2017 and 2014 Hypertension Guidelines With Cardiovascular Events and Deaths in US Adults: An Analysis of National Data.
Estimating the Association of the 2017 and 2014 Hypertension Guidelines With Cardiovascular Events and Deaths in US Adults: An Analysis of National Data.
复制标题
DOI：
10.1001/jamacardio.2018.1240
复制
发表时间：
2018-07-01
期刊：
影响因子：
24
通讯作者：
He J
中科院分区：
文献类型：
--
作者：
Bundy JD;Mills KT;Chen J;Li C;Greenland P;He J
2017年ACC/AHA高血压指南建议，与2014年循证高血压指南相比，启动降压药物和治疗目标的血压（BP）阈值更低。估计2017年和2014年高血压指南对定义为高血压或建议接受抗高血压治疗的美国成年人比例以及对降低主要心血管疾病（CVD）风险和全因死亡率的潜在影响。使用2013-2016年国家健康与营养检查调查（NHANES）的数据，我们估计了患有高血压或根据2017年和2014年高血压指南建议接受降压治疗的美国成年人的比例。使用来自NHANES、降压临床试验和基于人群的队列研究的数据，我们估计了CVD和全因死亡率的风险降低，假设整个美国成年人群达到指南推荐的收缩压（SBP）治疗目标。患有高血压或建议接受抗高血压治疗的个体比例和数量，以及CVD和全因死亡率降低的数量。根据2017年高血压指南，血压≥130/80 mmHg者占45.4%（95%置信区间[CI] 43.9-46.9%），代表105.3（1.019 - 1.088）亿美国成年人，显著高于2014年高血压指南的估计值（BP ≥140/90 mmHg）：分别为32.0%（30.3-33.6%）或74.1（70.3-77.9）百万例。此外，根据2017年高血压指南（35.9% [34.2-37.5%]）推荐接受降压治疗的个体比例（95% CI）显著高于2014年高血压指南（31.1% [29.6-32.7]）。实现2017年高血压指南SBP治疗目标估计可减少610，000例（95% CI 496，000 - 734，000）CVD事件和334，000例（245，000 - 434，000）≥40岁美国成人死亡。达到2014年高血压指南SBP治疗目标后的相应估计值分别为270，000（202，000 - 349，000）和177，000（123，000 - 241，000）。实施2017年高血压指南估计将增加62，000例低血压和79，000例急性肾损伤或衰竭事件。与2014年高血压指南相比，估计2017年高血压指南将显著增加推荐接受抗高血压治疗的成人比例，并进一步降低主要CVD事件和全因死亡率，但可能增加美国不良事件的数量。
The 2017 ACC/AHA hypertension guideline recommends lower blood pressure (BP) thresholds for initiating antihypertensive medication and treatment goals than the 2014 evidence-based hypertension guideline. To estimate the potential impacts of the 2017 and 2014 hypertension guidelines on the proportion of US adults defined as hypertensive or recommended for antihypertensive treatment and on risk reduction of major cardiovascular disease (CVD) and all-cause mortality. Using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2016, we estimated the proportions of US adults with hypertension or recommended for antihypertensive treatment according to the 2017 and 2014 hypertension guidelines. Using data from NHANES, antihypertensive clinical trials, and population-based cohort studies, we estimated risk reductions of CVD and all-cause mortality assuming the entire US adult population achieved guideline-recommended systolic BP (SBP) treatment goals. Proportions and numbers of individuals with hypertension or recommended for antihypertensive treatment and numbers of CVD and all-cause mortality reduction. According to the 2017 hypertension guideline, the prevalence of hypertension (BP ≥130/80 mmHg) was 45.4% (95% confidence interval [CI] 43.9-46.9%), representing 105.3 (101.9-108.8) million US adults, which was significantly higher than estimates per the 2014 hypertension guideline (BP ≥140/90 mmHg): 32.0% (30.3-33.6%) or 74.1 (70.3-77.9) million individuals, respectively. Additionally, the proportion (95% CI) of individuals recommended for antihypertensive treatment was significantly higher according to the 2017 hypertension guideline (35.9% [34.2-37.5%]) compared to the 2014 hypertension guideline (31.1% [29.6-32.7]). Achieving the 2017 hypertension guideline SBP treatment goals is estimated to reduce 610,000 (95% CI 496,000-734,000) CVD events and 334,000 (245,000-434,000) total deaths in US adults aged ≥40 years. Corresponding estimates after achieving the 2014 hypertension guideline SBP treatment goals were 270,000 (202,000-349,000) and 177,000 (123,000-241,000), respectively. Implementing the 2017 hypertension guideline is estimated to increase 62,000 hypotension and 79,000 acute kidney injury or failure events. Compared to the 2014 hypertension guideline, the 2017 hypertension guideline was estimated to significantly increase the proportion of adults recommended for antihypertensive treatment and further reduce major CVD events and all-cause mortality, but may increase the number of adverse events in the U.S.
登录
查看更多内容
影响因子：
2
作者：
Achana, Felix A.;Cooper, Nicola J.;Sutton, Alex J.
通讯作者：
Sutton, Alex J.
影响因子：
5.7
作者：
Margolis, Karen L.;Palermo, Lisa;Schwartz, Ann V.
通讯作者：
Schwartz, Ann V.
影响因子：
168.9
作者：
Lewington, S;Clarke, R;Collins, R
通讯作者：
Collins, R
影响因子：
5
作者：
Bild, DE;Bluemke, DA;Tracy, RP
通讯作者：
Tracy, RP
影响因子：
39.2
作者：
Levey AS;Stevens LA;Schmid CH;Zhang YL;Castro AF 3rd;Feldman HI;Kusek JW;Eggers P;Van Lente F;Greene T;Coresh J;CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
通讯作者：
CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)