Potential US Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline.
Potential US Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline.
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DOI：
10.1161/circulationaha.117.032582
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发表时间：
2018-01-09
期刊：
影响因子：
37.8
通讯作者：
Whelton PK
中科院分区：
文献类型：
--
作者：
Muntner P;Carey RM;Gidding S;Jones DW;Taler SJ;Wright JT Jr;Whelton PK
2017年美国心脏病学院/美国心脏协会（ACC/AHA）针对成人高血压的预防，检测，评估和管理指南，为高血压，收缩压和舒张压（BP）阈值定义提供了建议降压药物和BP目标目标。
这项研究的目的是确定高血压的患病率，建议对降压药的建议的意义以及BP在美国成年人中使用2017年ACC/AHA的标准以及美国成年人在治疗目标之上的普遍性，以及联合国家预防委员会的第七次报告，高血压（JNC7）指南的检测，评估和治疗。
我们分析了2011 - 2014年国家健康和营养检查调查的数据（n = 9,623）（国家健康和营养检查调查）。协议和平均结果加权以产生美国的估计。
根据2017年ACC/AHA和JNC7指南，美国成年人中高血压的总体普遍存在为45.6％（95％置信区间[CI] 43.6％，47.6％）和31.9％（95％CI 30.1％，33.7％）与美国成年人相比，建议分别使用36.2％（95％CI 34.2％，38.2％）和34.3％（32.5％，36.2％）的降压药。 JNC7的降压药，2017年ACC/AHA指南的治疗方法（JNC7）具有较高的心血管疾病（CVD）风险。不建议在美国成年人中服用降压药，53.4％（95％CI 49.9％，56.8％）和39.0％ （95％CI 36.4％，41.6％）根据2017年ACC/AHA和JNC7指南的治疗目标高于治疗目标。 /AHA指南，其中建议使用81.9（95％CI 73.8，90.1）百万的降压药。
与JNC 7指南相比，2017年ACC/AHA指南会导致高血压患病率大幅增加，但美国成年人的百分比略有增加，建议使用降压药。根据2017 ACC/AHA指南降低BP。
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults provides recommendations for the definition of hypertension, systolic and diastolic blood pressure (BP) thresholds for initiation of antihypertensive medication and BP target goals. The objective of this study was to determine the prevalence of hypertension, implications of recommendations for antihypertensive medication and prevalence of BP above the treatment goal among US adults using criteria from the 2017 ACC/AHA and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) guidelines. We analyzed data from the 2011–2014 National Health and Nutrition Examination Survey (N=9,623). NHANES (National Health and Nutrition Examination Survey) participants completed study interviews and an examination. For each participant, blood pressure was measured three times following a standardized protocol and averaged. Results were weighted to produce US population estimates. According to the 2017 ACC/AHA and JNC7 guidelines, the overall crude prevalence of hypertension among US adults was 45.6% (95% confidence interval [CI] 43.6%,47.6%) and 31.9% (95%CI 30.1%, 33.7%), respectively, and antihypertensive medication was recommended for 36.2% (95%CI 34.2%, 38.2%) and 34.3% (32.5%, 36.2%) of US adults, respectively. Compared to US adults recommended antihypertensive medication by JNC7, those recommended treatment by the 2017 ACC/AHA guideline but not JNC7 had higher cardiovascular disease (CVD) risk. Non-pharmacological intervention is advised for the 9.4% of US adults with hypertension according to the 2017 ACC/AHA guideline who are not recommended antihypertensive medication. Among US adults taking antihypertensive medication, 53.4% (95%CI 49.9%, 56.8%) and 39.0% (95%CI 36.4%, 41.6%) had BP above the treatment goal according to the 2017 ACC/AHA and JNC7 guidelines, respectively. Overall, 103.3 (95%CI 92.7, 114.0) million US adults had hypertension according to the 2017 ACC/AHA guideline of whom 81.9 (95%CI 73.8, 90.1) million were recommended antihypertensive medication. Compared with the JNC 7 guideline, the 2017 ACC/AHA guideline results in a substantial increase in the prevalence of hypertension but a small increase in the percentage of U.S. adults recommended antihypertensive medication. A substantial proportion of US adults taking antihypertensive medication is recommended more intensive BP lowering under the 2017 ACC/AHA guideline.