Insight into blood pressure targets for universal coverage of hypertension services in Iran: the 2017 ACC/AHA versus JNC 8 hypertension guidelines
Insight into blood pressure targets for universal coverage of hypertension services in Iran: the 2017 ACC/AHA versus JNC 8 hypertension guidelines
复制标题
DOI：
10.1186/s12889-020-8450-1
复制
发表时间：
2020-03-17
影响因子：
4.5
通讯作者：
Farzadfar, Farshad
中科院分区：
文献类型：
--
作者：
Mahdavi, Mahdi;Parsaeian, Mahboubeh;Farzadfar, Farshad
背景：根据两份高血压指南，我们比较了伊朗高血压的患病率、意识、治疗和控制；2017年ACC/AHA的血压目标为130/80 mmHg，而常用的JNC8指南临界值为140/90 mmHg。我们阐明了2017年ACC/AHA对有资格接受非药物和药物治疗的人群亚组和高风险个体的影响。方法数据来源于伊朗国家STEPS 2016研究。参与者包括27,738名25岁的成年人，作为伊朗人的代表性样本。使用调查设计的回归模型来检查高血压患病率、意识、治疗和控制的决定因素。结果基于JNC8的高血压患病率为29.9% (95% CI: 29.2-30.6)，而基于2017年ACC/AHA的高血压患病率飙升至53.7%（52.9-54.4）。基于JNC8的认知、治疗和控制比例分别为59.2%（58.0 ~ 60.3）、80.2%（78.9 ~ 81.4）和39.1%(37.4 ~ 40.7)，而采用2017 ACC/AHA的认知、治疗和控制比例分别为37.1%（36.2 ~ 38.0）、71.3%（69.9 ~ 72.7）和19.6%（18.3 ~ 21.0）。根据新的指南，25-34岁的成年人的患病率增幅最大（从7.3%增至30.7%）。他们的知晓率和治疗率也最低，与年龄组间最高的控制率（36.5%）相反。根据2017年ACC/AHA，与JNC8相比，血脂异常、高甘油三酯、糖尿病和心血管疾病事件的患者分别增加了24%、15%、17%和11%。然而，根据2017年ACC/AHA， 68.2%的高血压患者有资格接受药物治疗（JNC8为95.7%）。低密度脂蛋白胆固醇< 130 mg/dL，充分的身体活动（代谢当量>= 600/周）和体重指数分别使血压改变- 3.56(- 4.38,- 2.74),- 2.04（- 2.58,- 1.50）和0.48(0.42,0.53)mmHg。从JNC8到2017年ACC/AHA的转换急剧增加了伊朗的患病率，并急剧降低了人们的认识、治疗和控制。根据2017年ACC/AHA，更多的年轻人和患有慢性合并症的人属于高血压类别；这些人可能受益于早期干预，如改变生活方式。接受治疗的个体控制率低，值得对高血压服务进行严格审查。
Background We compared the prevalence, awareness, treatment, and control of hypertension in Iran based on two hypertension guidelines; the 2017 ACC/AHA -with an aggressive blood pressure target of 130/80 mmHg- and the commonly used JNC8 guideline cut-off of 140/90 mmHg. We shed light on the implications of the 2017 ACC/AHA for population subgroups and high-risk individuals who were eligible for non-pharmacologic and pharmacologic therapies. Methods Data was obtained from the Iran national STEPS 2016 study. Participants included 27,738 adults aged >= 25 years as a representative sample of Iranians. Regression models of survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension. Results The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) based on the 2017 ACC/AHA. The percentage of awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0), respectively, by applying the 2017 ACC/AHA. Based on the new guideline, adults aged 25-34 years had the largest increase in prevalence (from 7.3 to 30.7%). They also had the lowest awareness and treatment rate, contrary to the highest control rate (36.5%) between age groups. Compared with JNC8, based on the 2017 ACC/AHA, 24, 15, 17, and 11% more individuals with dyslipidaemia, high triglycerides, diabetes, and cardiovascular disease events, respectively, fell into the hypertensive category. Yet, based on the 2017 ACC/AHA, 68.2% of individuals falling into the hypertensive category were eligible for receiving pharmacologic therapy (versus 95.7% in JNC8). LDL cholesterol< 130 mg/dL, sufficient physical activity (Metabolic Equivalents >= 600/week), and Body Mass Index were found to change blood pressure by - 3.56(- 4.38, - 2.74), - 2.04(- 2.58, - 1.50), and 0.48(0.42, 0.53) mmHg, respectively. Conclusions Switching from JNC8 to 2017 ACC/AHA sharply increased the prevalence and drastically decreased the awareness, treatment, and control in Iran. Based on the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category; these individuals might benefit from earlier interventions such as lifestyle modifications. The low control rate among individuals receiving treatment warrants a critical review of hypertension services.