Potential need for expanded pharmacologic treatment and lifestyle modification services under the 2017 ACC/AHA Hypertension Guideline
Potential need for expanded pharmacologic treatment and lifestyle modification services under the 2017 ACC/AHA Hypertension Guideline
复制标题
DOI：
10.1111/jch.13364
复制
发表时间：
2018-10-01
影响因子：
2.8
通讯作者：
Hong, Yuling
中科院分区：
文献类型：
--
作者：
Ritchey, Matthew D.;Gillespie, Cathleen;Hong, Yuling
2017年ACC/AHA高血压指南的应用扩大了需要血压（BP）管理的美国成年人的数量。作者使用2011 - 2014年NHANES数据来描述受新指南影响最大的人群，与之前的JNC-7指南相比，并描述了推荐新的或强化的药物治疗和/或生活方式改变的成年人与卫生保健部门的先前相互作用。2017年高血压指南将3230万美国成年人重新分类为新发高血压，并建议对1.337亿成年人进行BP相关治疗，其中5780万血压不受控制的成年人建议开始或加强药物治疗，5050万新建议仅改变生活方式。估计有1310万（22.7%）成年人建议开始或加强药物治疗，2060万（40.8%）成年人新建议的生活方式改变单独报告没有建立医疗保健联系。在新推荐的仅改变生活方式的成年人中，根据JNC-7，从不推荐干预重新分类到推荐的仅改变生活方式的几率对于与护理建立联系的成年人较低（aOR：0.78 [95% CI：0.67 - 0.91]），随年龄增长而下降，男性（1.72 [1.52 - 1.94]）高于女性，肥胖成人（1.23 [1.00 - 1.53]）高于正常或体重不足成人。2017年高血压指南的应用增加了需要开始或加强BP治疗的美国成年人的数量并改变了其分布。这包括确定数百万以前与医疗保健互动有限的美国成年人，现在推荐新的或强化的药物治疗和/或生活方式改变。
Application of the 2017 ACC/AHA Hypertension Guideline expands the number of US adults requiring blood pressure (BP) management. The authors use 2011-2014 NHANES data to describe the population groups most affected by the new guideline, compared with the previous JNC-7 guideline, and describe the previous interaction with the health care sector among those adults recommended new or intensified pharmacologic treatment and/or lifestyle modification. The 2017 Hypertension Guideline reclassifies 32.3 million US adults as newly hypertensive and recommends BP-related treatment of 133.7 million adults, including 57.8 million with uncontrolled BP recommended to initiate or intensify pharmacologic treatment and 50.5 million newly recommended lifestyle modification alone. An estimated 13.1 million (22.7%) adults recommended to initiate or intensify pharmacologic treatment, and 20.6 million (40.8%) adults newly recommended lifestyle modification alone report not having established health care linkages. Among the adults newly recommended lifestyle modification alone, the odds of reclassification from no recommended intervention, under JNC-7, to recommended lifestyle modification alone were lower for adults with established linkages to care (aOR: 0.78 [95% CI: 0.67-0.91]) compared to those without, decreased with increasing age, were greater for men (1.72 [1.52-1.94]) compared to women and were greater for obese adults (1.23 [1.00-1.53]) compared with normal or underweight adults. Application of the 2017 Hypertension Guideline increases the number and alters the distribution of US adults in need of initiating or intensifying BP treatment. This includes identifying millions of US adults who previously had limited interaction with health care and are now recommended new or intensified pharmacologic treatment and/or lifestyle modification.