The 2017 American College of Cardiology/American Heart Association Hypertension Guideline and Blood Pressure in Older Adults.
The 2017 American College of Cardiology/American Heart Association Hypertension Guideline and Blood Pressure in Older Adults.
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2017 年美国心脏病学会/美国心脏协会高血压指南和老年人血压。
DOI：
10.1016/j.amepre.2023.04.011
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发表时间：
2023
影响因子：
5.5
通讯作者：
Khan,SadiyaS
中科院分区：
文献类型：
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作者：
Wang,MichaelC;Petito,LuciaC;Pool,LindsayR;Foti,Kathryn;Juraschek,StephenP;McEvoy,JohnW;Nambi,Vijay;Carnethon,MercedesR;Michos,ErinD;Khan,SadiyaS
2017年美国心脏病学会/美国心脏协会血压指南重新定义了高血压，降低了血压治疗目标。需要关于指南影响的经验数据。方法分析社区动脉粥样硬化风险研究参与者的数据，这些参与者参加了基线指南前（2016-2017）和指南后（2018-2019）就诊，基线收缩压在120 - 159 mmHg之间。受试者根据基线收缩压在新指南下的分级变化分组如下：未重新分级（120-129 mmHg），重新分级为1期高血压（130-139 mmHg），重新分级为2期高血压（140-159 mmHg）。计算基线和随访之间收缩压变化、降压药使用变化以及达到指南后推荐（收缩压<130 mmHg）的百分比的平均值和95% ci。分析在2021-2022年进行。结果在2193名基线年龄为71-95岁的社区居民动脉粥样硬化风险参与者中，基线和随访期间收缩压变化在未重新分类（+4.1 mmHg, 95% CI=3.0, 5.3 mmHg），重新分类为1期高血压（-1.1 mmHg, 95% CI= -2.2, 0.1 mmHg）和重新分类为2期高血压（-5.7 mmHg, 95% CI= -6.8, -4.7 mmHg）的参与者中有所不同。在1期高血压患者中，降压药使用率从77.3%上升到78.4% (p=0.25)，在2期高血压患者中，降压药使用率从78.3%上升到81.4% （p<0.01）。在随访中，41.8%的1期和22.4%的2期高血压组达到了收缩压<130 mmHg的目标。根据2017年美国心脏病学会/美国心脏协会指南，被重新分类为2期高血压的老年人收缩压有小幅下降，降压治疗有小幅增加，但被重新分类为1期高血压的老年人没有。
IntroductionThe 2017 American College of Cardiology/American Heart Association blood pressure guideline redefined hypertension and lowered the blood pressure treatment target. Empirical data on the guideline's impact are needed.MethodsData were analyzed from Atherosclerosis Risk in Communities study participants who attended baseline pre-guideline (2016–2017) and post-guideline (2018–2019) visits with baseline systolic blood pressure between 120 and 159 mmHg. Participants were grouped according to baseline systolic blood pressure by change in classification under the new guideline as follows: not reclassified (120–129 mmHg), reclassified to Stage 1 hypertension (130–139 mmHg), and reclassified to Stage 2 hypertension (140–159 mmHg). Means and 95% CIs for systolic blood pressure changes between baseline and follow-up, changes in antihypertensive use, and percentages that achieved the post-guideline recommendation (systolic blood pressure <130 mmHg) were calculated. Analyses were performed in 2021–2022.ResultsAmong 2,193 community-dwelling Atherosclerosis Risk in Communities participants aged 71–95 years at baseline, systolic blood pressure changes between baseline and follow-up visits differed among participants not reclassified (+4.1 mmHg, 95% CI=3.0, 5.3 mmHg), reclassified to Stage 1 hypertension (–1.1 mmHg, 95% CI= –2.2, 0.1 mmHg), and reclassified to Stage 2 hypertension (–5.7 mmHg, 95% CI= –6.8, –4.7 mmHg). Antihypertensive use changed from 77.3% to 78.4% (p=0.25) among participants reclassified to Stage 1 hypertension and from 78.3% to 81.4% (p<0.01) among participants reclassified to Stage 2 hypertension. At follow-up, 41.8% of the Stage 1 and 22.4% of the Stage 2 hypertension groups reached the systolic blood pressure <130 mmHg goal.ConclusionsThere were small decreases in systolic blood pressure and increases in antihypertensive therapy among older adults reclassified to Stage 2 hypertension but not among those reclassified to Stage 1 hypertension by the 2017 American College of Cardiology/American Heart Association guideline.