Impact of 2017 ACC/AHA guidelines on prevalence of hypertension and eligibility for antihypertensive treatment in United States and China: nationally representative cross sectional study.
Impact of 2017 ACC/AHA guidelines on prevalence of hypertension and eligibility for antihypertensive treatment in United States and China: nationally representative cross sectional study.
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DOI：
10.1136/bmj.k2357
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发表时间：
2018-07-11
期刊：
影响因子：
--
通讯作者：
Krumholz HM
中科院分区：
文献类型：
--
作者：
Khera R;Lu Y;Lu J;Saxena A;Nasir K;Jiang L;Krumholz HM
研究2017年美国心脏病学会（ACC）/美国心脏协会（AHA）高血压指南对美国和中国全国代表性人群高血压患病率以及开始和强化治疗资格的影响。国家代表性数据的观察评估。最近两个周期（2013-14，2015-16）的美国国家健康与营养调查（NHANES）和中国健康与退休纵向研究（CHARLS）（2011-12）。所有45-75岁的成年人，根据ACC/AHA指南诊断为高血压，并与现行指南进行比较。诊断为高血压，并有资格开始和加强抗高血压治疗。在美国采用2017年ACC/AHA高血压指南将在45-75岁年龄组中标记7010万（95%置信区间64.9至75.3）人患有高血压，占该年龄组人口的63%（60.6%至65.4%）。在中国采用这些标准将导致2.669亿（2.529 - 2.808）万人或55%（53.4%-56.7%）的同一年龄组被标记为高血压。这意味着美国和中国的患病率分别增加了26.8%（23.2%至30.9%）和45.1%（41.3%至48.9%）。此外，根据治疗模式和当前指南，有810万（650万至970万）美国高血压患者未经治疗，在ACC/AHA指南实施后，这一数字预计将增加到1560万（1360万至1770万）。在中国，根据目前的治疗模式，7450万（6410万至8480万）高血压患者未经治疗，估计将增加到12980万（11870万至14090万）。此外，ACC/AHA指南将美国的870万（6.0至11.5）万成年人和中国的5100万（40.3至61.6）万成年人标记为不需要降压治疗的高血压，而目前的指南分别为150万（1.2至2.1）万和23.4（12.1至35.1）万。最后，即使在接受治疗的人中，需要强化治疗的比例估计也增加了13.9（1 220万至1 560万）（从24.0%至54.4%的治疗患者），以及30如果采用ACC/AHA治疗目标，则中国有2430 - 3570万（占治疗患者的41.4%-76.2%）。如果2017年ACC/AHA高血压指南获得通过，将显著增加美国和中国被标记为高血压并接受药物治疗的人数，导致两国超过一半的45-75岁人群被认为是高血压。
To examine the effect of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines on the prevalence of hypertension and eligibility for initiation and intensification of treatment in nationally representative populations from the United States and China. Observational assessment of nationally representative data. US National Health and Nutrition Examination Survey (NHANES) for the most recent two cycles (2013-14, 2015-16) and China Health and Retirement Longitudinal Study (CHARLS) (2011-12). All 45-75 year old adults who would have a diagnosis of hypertension and be candidates for treatment on the basis of the ACC/AHA guidelines, compared with current guidelines. Diagnosis of hypertension and candidacy for initiation and intensification of antihypertensive treatment. Adoption of the 2017 ACC/AHA hypertension guidelines in the US would label 70.1 (95% confidence interval 64.9 to 75.3) million people in the 45-75 year age group as having hypertension, representing 63% (60.6% to 65.4%) of the population in this age group. Their adoption in China would lead to labeling of 266.9 (252.9 to 280.8) million people or 55% (53.4% to 56.7%) of the same age group as having hypertension. This would represent an increase in prevalence of 26.8% (23.2% to 30.9%) in the US and 45.1% (41.3% to 48.9%) in China. Furthermore, on the basis of treatment patterns and current guidelines, 8.1 (6.5 to 9.7) million Americans with hypertension are untreated, which would be expected to increase to 15.6 (13.6 to 17.7) million after the implementation of the ACC/AHA guidelines. In China, on the basis of current treatment patterns, 74.5 (64.1 to 84.8) million patients with hypertension are untreated, estimated to increase to 129.8 (118.7 to 140.9 million. In addition, the ACC/AHA guidelines would label 8.7 (6.0 to 11.5) million adults in the US and 51 (40.3 to 61.6) million in China as having hypertension that would not require antihypertensive treatment, compared with 1.5 (1.2 to 2.1) million and 23.4 (12.1 to 35.1) million with the current guidelines. Finally, even among people receiving treatment, the proportion that are candidates for intensification of treatment is estimated to increase by 13.9 (12.2 to 15.6) million (from 24.0% to 54.4% of treated patients) in the US, and 30 (24.3 to 35.7) million (41.4% to 76.2% of treated patients) in China, if the ACC/AHA treatment targets are adopted. If adopted, the 2017 ACC/AHA hypertension guidelines will markedly increase the number of people labeled as having hypertension and treated with drugs in both the US and China, leading to more than half of those aged 45-75 years in both countries being considered hypertensive.
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