Variation in the Proportion of Adults in Need of Blood Pressure-Lowering Medications by Hypertension Care Guideline in Low- and Middle-Income Countries: A Cross-Sectional Study of 1 037 215 Individuals From 50 Nationally Representative Surveys.
Variation in the Proportion of Adults in Need of Blood Pressure-Lowering Medications by Hypertension Care Guideline in Low- and Middle-Income Countries: A Cross-Sectional Study of 1 037 215 Individuals From 50 Nationally Representative Surveys.
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DOI：
10.1161/circulationaha.120.051620
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发表时间：
2021-03-09
期刊：
影响因子：
37.8
通讯作者：
Geldsetzer P
中科院分区：
文献类型：
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作者：
Sudharsanan N;Theilmann M;Kirschbaum TK;Manne-Goehler J;Azadnajafabad S;Bovet P;Chen S;Damasceno A;De Neve JW;Dorobantu M;Ebert C;Farzadfar F;Gathecha G;Gurung MS;Jamshidi K;Jørgensen JMA;Labadarios D;Lemp J;Lunet N;Mwangi JK;Moghaddam SS;Bahendeka SK;Zhumadilov Z;Bärnighausen T;Vollmer S;Atun R;Davies JI;Geldsetzer P
目前的高血压指南在对谁应该提供降压药物的定义上有很大的不同。了解指南选择对需要治疗的成年人比例的影响对于规划和扩大低收入和中等收入国家（LMIC）的高血压护理至关重要。我们从50个LMIC（N = 1，037，215）的全国代表性调查中提取了年龄、性别、血压、高血压治疗和诊断状况、吸烟和30-70岁成人体重指数的横断面数据。我们的主要目的是确定高血压指南的选择对需要降压药物的成年人比例的影响。我们考虑了四个高血压指南：2017年美国心脏病学会/美国心脏协会（ACC/AHA）指南，常用的140/90 mmHg阈值，2016年世界卫生组织HEARTS指南（WHO）和2019年英国国家健康与护理卓越研究所（NICE）指南。根据ACC/AHA指南，需要降压药物的成年人比例最高，其次是140/90，NICE和WHO指南（ACC/AHA：女性，27.7% [95% CI：27.2%，28.2%]，男性，35.0% [34.4%，35.7%]; 140/90：女性：26.1% [25.5%，26.6%]，男性，31.2% [30.6%，31.9%]; NICE：女性，11.8% [11.4%，12.1%];男性，15.7% [15.3%，16.2%];世卫组织：女性，9.2% [8.9%，9.5%]，男性，11.0% [10.6%，11.4%]）。不知道自己患有高血压的个体是导致不同指南标准下需要治疗的比例差异的主要原因。在65-69岁年龄组中，需要降压药物的比例差异最大（ACC/AHA：女性，60.2% [58.8%，61.6%]，男性，70.1% [68.8%，71.3%];世卫组织：女性，20.1% [18.8%，21.3%]，男性，24.1.0% [22.3%，25.9%]）。就女性和男性而言，在所有准则中，欧洲和东地中海区域国家需要降压药物的成年人比例最高，而南美洲和中美洲的比例最低。根据使用的高血压指南，需要降压药物的成年人比例存在很大差异。鉴于这一选择对卫生系统能力的重大影响，决策者需要仔细考虑在扩大本国高血压护理时应采用哪种指导方针。
Current hypertension guidelines vary substantially in their definition of who should be offered blood-pressure-lowering medications. Understanding the impact of guideline choice on the proportion of adults who require treatment will be crucial for planning and scaling up hypertension care in low- and middle-income countries (LMICs). We extracted cross-sectional data on age, sex, blood pressure, hypertension treatment and diagnosis status, smoking, and body mass index for adults ages 30–70 from nationally representative surveys in 50 LMICs (N = 1,037,215). Our main objective was to determine the impact of hypertension guideline choice on the proportion of adults in need of blood-pressure-lowering medications. We considered four hypertension guidelines: the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline, the commonly used 140/90 mmHg threshold, the 2016 World Health Organization HEARTS guideline (WHO), and the 2019 United Kingdom National Institute for Health and Care Excellence (NICE) guideline. The proportion of adults in need of blood-pressure-lowering medications was highest under the ACC/AHA followed by the 140/90, NICE, and WHO guidelines (ACC/AHA: women, 27.7% [95% CI: 27.2%, 28.2%], men, 35.0% [34.4%, 35.7%]; 140/90: women: 26.1% [25.5%, 26.6%], men, 31.2% [30.6%, 31.9%]; NICE: women, 11.8% [11.4%, 12.1%]; men, 15.7% [15.3%, 16.2%]; WHO: women, 9.2% [8.9%, 9.5%], men, 11.0% [10.6%,11.4%]). Individuals who were unaware that they have hypertension were the primary contributor to differences in the proportion needing treatment under different guideline criteria. Differences in the proportion needing blood-pressure-lowering medications were largest in the oldest, 65–69, age group (ACC/AHA: women, 60.2% [58.8%, 61.6%], men, 70.1% [68.8%, 71.3%]; WHO: women, 20.1% [18.8%, 21.3%], men, 24.1.0% [22.3%, 25.9%]). For both women and men and across all guidelines, countries in the European and Eastern Mediterranean regions had the highest proportion of adults in need of blood-pressure-lowering medicines while the South and Central Americas had the lowest. There was substantial variation in the proportion of adults in need of blood-pressure-lowering medications depending on which hypertension guideline was used. Given the great implications of this choice for health system capacity, policymakers will need to carefully consider which guideline they should adopt when scaling up hypertension care in their country.