Lifetime Risks for Hypertension by Contemporary Guidelines in African American and White Men and Women
Lifetime Risks for Hypertension by Contemporary Guidelines in African American and White Men and Women
复制标题
DOI：
10.1001/jamacardio.2019.0529
复制
发表时间：
2019-05-01
期刊：
影响因子：
24
通讯作者：
Wilkins, John T.
中科院分区：
文献类型：
--
作者：
Chen, Vincent;Ning, Hongyan;Wilkins, John T.
根据美国心脏协会和美国心脏病学会（AHA/ACC） 2017年高血压阈值（>= 130/80mmHg），成人高血压风险发展模式和高血压终生风险尚不清楚。在AHA/ACC 2017和第七届全国联合委员会（JNC7）高血压阈值下，量化和比较白人和非洲裔美国男性和女性的高血压终生风险。设计、环境和参与者我们使用了心血管终身风险汇总项目中三个当代队列的个人水平汇总数据：Framingham后代研究、年轻人冠状动脉风险发展研究和社区动脉粥样硬化风险研究。这些以社区为基础的队列包括在多队列检查中进行血压评估的白人和非裔美国男性和女性。主要结局和测量：20岁至85岁高血压的累积终生风险，调整了竞争死亡风险和基线高血压患病率。在AHA/ACC阈值下的偶发性高血压是通过单次血压测量130/80 mm Hg或更高或自我报告使用抗高血压药物来定义的。JNC7阈值以下的偶发性高血压是通过单次血压测量140/90 mm Hg或更高或使用抗高血压药物来定义的。结果：共有13160名参与者参与了22600人年的随访；数据集包括6313名基线参与者的个人数据（中位年龄25岁），以及来自社区动脉粥样硬化风险研究和Framingham后代研究中年龄较大的参与者的个人数据。在进入数据集的20至30岁的参与者中，在AHA/ACC 2017阈值下的高血压基线患病率在白人男性中为30.7%（1790人中有549人），在非洲裔美国男性中为23.1%（1063人中有245人），在白人女性中为10.2%（2070人中有210人），在非洲裔美国女性中为12.3%（1390人中有171人）。白人男性高血压的终生风险为83.8% (95% CI, 82.5%-85.0%)；非裔美国男性，86.1%(95% CI, 84.1%-88.1%)；白人女性，69.3%(95% CI, 67.8%-70.7%)；非裔美国女性为85.7%（95% CI, 84.0%-87.5%）。这些高于JNC7阈值下高血压的相应终生风险（白人男性，60.5%[95% CI, 58.9%-62.1%]；非洲裔美国男性，74.7%[95% CI, 71.9%-77.5%]；白人女性，53.9%[95% CI, 52.5%-55.4%]；非洲裔美国女性，77.3%[95% CI, 75.0%-79.5%]）。根据AHA/ACC 2017高血压血压阈值，非裔美国男性、女性和白人男性的高血压终生风险超过75%。此外，血压在130/80毫米汞柱或更高的患病率在青年期非常高，这表明预防高血压发展的努力应在生命历程的早期集中。
IMPORTANCE Patterns of hypertension risk development over the adult lifespan and lifetime risks for hypertension under the American Heart Association and American College of Cardiology (AHA/ACC) 2017 thresholds for hypertension (>= 130/80mmHg) are unknown.OBJECTIVE To quantify and compare lifetime risks for hypertension in white and African American men and women under the AHA/ACC 2017 and the Seventh Joint National Commission (JNC7) hypertension thresholds.DESIGN, SETTING, AND PARTICIPANTS We used individual-level pooled data from 3 contemporary cohorts in the Cardiovascular Lifetime Risk Pooling Project: the Framingham Offspring Study, the Coronary Artery Risk Development in Young Adults study, and Atherosclerosis Risk in Communities study. These community-based cohorts included white and African American men and women with blood pressure assessment at multiple cohort examinations.MAIN OUTCOMES AND MEASURES Cumulative lifetime risk for hypertension from ages 20 through 85 years, adjusted for competing risk of death and baseline hypertension prevalence. Incident hypertension under the AHA/ACC threshold was defined by a single-occasion blood pressure measurement of 130/80 mm Hg or more or self-reported use of antihypertensive medications. Incident hypertension under the JNC7 threshold was defined by a single-occasion blood pressure measurement of 140/90 mm Hg or more or the use of antihypertensive medications.RESULTS A total of 13 160 participants contributed 227 600 person-years of follow-up; the data set included individual-level data on 6313 participants at baseline (median age, 25 years), plus person-year data from participants in the Atherosclerosis Risk in Communities and Framingham Offspring studies who enrolled at older ages. Baseline prevalence of hypertension under the AHA/ACC 2017 threshold in participants entering the data set between 20 and 30 years of age was 30.7% in white men (n = 549 of 1790), 23.1% in African American men (n = 245 of 1063), 10.2% in white women (n = 210 of 2070), and 12.3% in African American women (n = 171 of 1390). White men had lifetime risk of hypertension of 83.8% (95% CI, 82.5%-85.0%); African American men, 86.1%(95% CI, 84.1%-88.1%); white women, 69.3%(95% CI, 67.8%-70.7%); and African American women, 85.7%(95% CI, 84.0%-87.5%). These were greater than corresponding lifetime risks under the JNC7 threshold for hypertension (white men, 60.5%[95% CI, 58.9%-62.1%]; African American men, 74.7%[95% CI, 71.9%-77.5%]; white women, 53.9%[95% CI, 52.5%-55.4%]; and African American women, 77.3%[95% CI, 75.0%-79.5%]).CONCLUSIONS AND RELEVANCE Under the AHA/ACC 2017 blood pressure threshold for hypertension, lifetime risks for hypertension exceeded 75% for African American men and women and white men. Furthermore, prevalence of blood pressure of 130/80 mm Hg or more is very high in young adulthood, suggesting that efforts to prevent development of hypertension should be focused early in the life course.