Prevalence of Hypertension and Cardiovascular Risk According to Blood Pressure Thresholds Used for Diagnosis.
Prevalence of Hypertension and Cardiovascular Risk According to Blood Pressure Thresholds Used for Diagnosis.
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DOI：
10.1161/hypertensionaha.118.11609
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发表时间：
2018-09
期刊：
影响因子：
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通讯作者：
de Boer IH
中科院分区：
文献类型：
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作者：
Lamprea-Montealegre JA;Zelnick LR;Hall YN;Bansal N;de Boer IH
我们试图根据用于诊断的血压阈值估计美国高血压的患病率和高血压成人的特征，并估计其相关的CVD风险。分析包括2013-2014年国家健康和营养检查调查（NHANES）中20岁或以上的成年人（N= 5，389），并招募参与者参加Syphilis血压干预试验（SPRINT）（N= 9，361）和控制糖尿病心血管风险的行动-BP试验（ACCORD-BP）（N= 4，733）试验。在NHANES中，患病率估计包括在两个不同场合观察到血压升高的概率。使用130/80 mm Hg或更高的新BP阈值，大约2400万新的美国成年人将被诊断为患有高血压，430万人将被建议开始抗高血压药物治疗。这些个体的平均动脉粥样硬化CVD风险（17%）低于SPRINT和ACCORD-BP参与者（22%和27%），并且不太可能患有流行性心血管疾病（9% vs 17%和34%）。在SPRINT和ACCORD-BP中，只有少数（9%和13%）受试者在基线时未接受降压药物治疗，这些受试者的CVD事件发生率显著低于基线BP药物治疗的受试者。我们的结论是，采用ACC/AHA指南将导致高血压的患病率和建议开始抗高血压药物治疗的美国成年人的数量大幅增加。这些人的心血管风险比以前在两个大型BP试验中研究的大多数参与者要低得多。
We sought to estimate the prevalence of hypertension and characteristics of hypertensive adults in the United States according to blood pressure thresholds used for diagnosis and estimate their associated CVD risk. Analyses included adults 20 years of age or older in the 2013-2014 National Health and Nutrition Examination Survey (NHANES) (N=5,389), and enrolled participants in the Systolic Blood Pressure Intervention Trial (SPRINT) (N=9,361) and the Action to Control Cardiovascular Risk in Diabetes-BP Trial (ACCORD-BP) (N=4,733) trials. In NHANES, prevalence estimates incorporated the probability of observing elevated blood pressure on two separate occasions. Using the new BP thresholds of 130/80 mm Hg or greater, approximately 24 million new American adults would be diagnosed as having hypertension and 4.3 million would be recommended to start antihypertensive medications. These individuals would have a lower mean atherosclerotic CVD risk (17%) than participants in SPRINT and ACCORD-BP (22% and 27%) and would be less likely to have prevalent cardiovascular disease (9% versus 17% and 34%). In SPRINT and ACCORD-BP, only a minority (9% and 13%) of participants were not on antihypertensive medications at baseline, and, rates of incident CVD in these participants were substantially lower compared to those on baseline BP medications. We conclude that adopting the ACC/AHA guidelines would lead to a substantial increase in the prevalence of hypertension and in the number of American adults recommended to start antihypertensive medications. These individuals would have a substantially lower cardiovascular risk than most participants previously studied in two large BP trials.