2017 ACC/AHA Blood Pressure Treatment Guideline Recommendations and Cardiovascular Risk.
2017 ACC/AHA Blood Pressure Treatment Guideline Recommendations and Cardiovascular Risk.
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DOI：
10.1016/j.jacc.2018.05.074
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发表时间：
2018-09-11
影响因子：
24
通讯作者：
Muntner P
中科院分区：
文献类型：
--
作者：
Colantonio LD;Booth JN 3rd;Bress AP;Whelton PK;Shimbo D;Levitan EB;Howard G;Safford MM;Muntner P
2017年美国心脏病学会/美国心脏协会（ACC/AHA）血压（BP）指南提供了抗高血压药物开始和强化的最新建议。确定2017年ACC/AHA BP指南建议和不建议开始或强化降压药物治疗的成人中心血管疾病（CVD）事件的风险。我们分析了卒中（REGARDS）研究参与者（年龄≥45岁）中黑人和白色人的地理和种族差异的原因。在基线（2003-2007年）测量两次收缩压（SBP）和舒张压（DBP）并取平均值。根据2017年ACC/AHA指南对未服用（n= 14，039）和服用（n= 15，179）降压药物的参与者开始和加强降压药物的建议进行分类。截至2014年12月31日，共有4，094起CVD事件（中风，冠心病和心力衰竭）发生。在未服用抗高血压药物的参与者中，34.4%被建议开始药物抗高血压治疗。在SBP/DBP ≥140/90 mmHg的受试者中，推荐开始抗高血压药物治疗的CVD事件发生率为22.7/1000人-年（95%CI 20.3-25.0）。在SBP/DBP为130-139/80-89 mmHg的受试者中，推荐和不推荐降压药物治疗的CVD事件发生率分别为20.5（95%CI 18.5-22.6）和3.4（95%CI 2.4-4.4）。在服用抗高血压药物的参与者中，62.8%的人被建议加强治疗。对于SBP/DBP ≥140/90 mmHg和130-139/80-89 mmHg的受试者，推荐强化治疗的受试者CVD事件发生率分别为33.6（95%CI 31.5-35.6）和22.4（95%CI 20.8-23.9）/1,000人-年。实施2017年ACC/AHA指南将指导具有高CVD风险的成年人开始和强化降压药物治疗。2017年美国心脏病学会/美国心脏协会（ACC/AHA）血压（BP）指南提供了抗高血压药物开始和强化的最新建议。在当前对≥45岁的卒中（REGARDS）研究受试者的地理和种族差异的黑人和白色原因进行的分析中，2017年ACC/AHA BP指南建议开始或强化降压药物治疗的受试者发生心血管事件和全因死亡的风险较高。这些结果表明，实施2017年ACC/AHA BP指南将指导抗高血压药物的启动和强化，使成年人的心血管事件和全因死亡率的绝对风险大幅降低。
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline provides updated recommendations for antihypertensive medication initiation and intensification. Determine the risk for cardiovascular disease (CVD) events among adults recommended and not recommended antihypertensive medication initiation or intensification by the 2017 ACC/AHA BP guideline. We analyzed data for black and white REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants (age ≥45 years). Systolic BP (SBP) and diastolic BP (DBP) were measured twice at baseline (2003–2007) and averaged. Participants not taking (n=14,039) and taking (n=15,179) antihypertensive medication were categorized according to their recommendations for antihypertensive medication initiation and intensification by the 2017 ACC/AHA guideline. Overall, 4,094 CVD events (stroke, coronary heart disease and heart failure) occurred by December 31, 2014. Among participants not taking antihypertensive medication, 34.4% were recommended pharmacological antihypertensive treatment initiation. The CVD event rate per 1,000 person-years among participants recommended antihypertensive medication initiation with SBP/DBP ≥140/90 mmHg was 22.7 (95%CI 20.3–25.0). Among participants with SBP/DBP 130–139/80–89 mmHg, the CVD event rate was 20.5 (95%CI 18.5–22.6) and 3.4 (95%CI 2.4–4.4) for those recommended and not recommended antihypertensive medication initiation, respectively. Among participants taking antihypertensive medication, 62.8% were recommended treatment intensification. The CVD event rate per 1,000 person-years among participants recommended treatment intensification was 33.6 (95%CI 31.5–35.6) and 22.4 (95%CI 20.8–23.9) for those with SBP/DBP ≥140/90 mmHg and 130–139/80–89 mmHg, respectively. Implementing the 2017 ACC/AHA guideline would direct antihypertensive medication initiation and intensification to adults with high CVD risk. The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline provides updated recommendations for antihypertensive medication initiation and intensification. In the current analysis of black and white REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants ≥45 years of age, those recommended antihypertensive medication initiation or intensification by the 2017 ACC/AHA BP guideline had high risk for cardiovascular events and all-cause mortality. These results indicate that implementing the 2017 ACC/AHA BP guideline would direct antihypertensive medication initiation and intensification to adults who will receive a substantial absolute risk reduction for cardiovascular events and all-cause mortality.
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影响因子：
5.4
作者：
Cornelissen VA;Smart NA
通讯作者：
Smart NA
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