Implications of the Eighth Joint National Committee Guidelines for the Management of High Blood Pressure for Aging Adults: Atherosclerosis Risk in Communities Study.
Implications of the Eighth Joint National Committee Guidelines for the Management of High Blood Pressure for Aging Adults: Atherosclerosis Risk in Communities Study.
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DOI：
10.1161/hypertensionaha.115.05560
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发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Folsom AR
中科院分区：
文献类型：
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作者：
Miedema MD;Lopez FL;Blaha MJ;Virani SS;Coresh J;Ballantyne CM;Folsom AR
最近由八个国家联合委员会小组发布的2014年循证成人高血压管理指南可能会对美国老龄化人口产生重大影响。我们对参加了第5次研究访问(2011-2013)的ARIC的黑人和白人参与者进行了横断面分析。坐着的血压是根据休息5分钟后连续3次读数的平均值计算出来的。通过检查带到访问的药物容器来记录目前开出的降压药。血压控制是使用第7和第8联合全国委员会阈值来定义的。在6088名参与者(平均年龄75.6岁[范围66-90]，女性58.4%，非裔美国人23.2%)中，54.9%的人患有糖尿病或慢性肾脏疾病。根据第七届全国联合委员会的高血压患病率为81.9%，整个样本中62.8%的人达到了血压目标。使用第8次全国联合委员会的阈值，79.4%的人达到了血压目标(16.6%被重新归类为目标)。糖尿病或慢性肾脏疾病患者的重新分类比例(20.6%)高于非糖尿病或慢性肾脏疾病患者(11.6%)。在我们的队列中，降压药的使用率很高，75.0%的人至少开了一种降压药，46.7%的人开了两种或两种以上的降压药。总而言之，在美国老年白人和黑人的队列中，根据第8届全国联合委员会的指南，大约每6人中就有1人被重新归类为血压在目标水平。尽管这些目标不那么激进，但超过20%的人仍然不受新标准的控制。
The recent 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Eight Joint National Committee Panel may significantly impact the aging US population. We performed a cross-sectional analysis of black and white participants in ARIC who participated in the 5th study visit (2011–2013). Sitting blood pressure was calculated from the average of 3 successive readings taken after a 5-minute rest. Currently prescribed antihypertensive medications were recorded by reviewing medication containers brought to the visit. Blood pressure control was defined using both the 7th and 8th Joint National Committee thresholds. Of 6,088 participants (mean age 75.6 years [range 66–90], 58.4% female, 23.2% African American), 54.9% had either diabetes or chronic kidney disease. The prevalence of hypertension according to 7th Joint National Committee thresholds was 81.9%, and 62.8% of the entire sample were at blood pressure goal. Using the 8th Joint National Committee thresholds, 79.4% were at blood pressure goal (16.6% were reclassified as at goal). Reclassification was higher for individuals with diabetes or chronic kidney disease (20.6%) compared to individuals without either condition (11.6%). Use of antihypertensive medications in our cohort was high, with 75.0% prescribed at least one antihypertensive medication and 46.7% on 2 or more antihypertensive agents. In conclusion, in a US cohort of aging white and black individuals, approximately 1 in 6 individuals were reclassified as having blood pressure at goal by 8th Joint National Committee guidelines. Despite these less aggressive goals, over 20% remain uncontrolled by the new criteria.