From the University of South Carolina School of Medicine, Greenville, Greenville Health System, Care Coordination Institute, Greenville (B.M.E., J.M.F., A.S.); Department of Mathematics, College of Charleston, Charleston, SC (J.L.); and Medical University of South Carolina, Department of Pediatrics, Nephrology Division, Charleston (I.F.S.).
Circulation. 2014 May 20;129(20):2052-61. doi: 10.1161/CIRCULATIONAHA.113.007699. Epub 2014 Apr 14.
Joint National Committee goal blood pressure for all adults was <140/<90 mm Hg or lower from 1984 to 2013. Adults aged ≥60 years (older) have mainly isolated systolic hypertension, with major trials attaining systolic blood pressure <150 but not <140 mm Hg. The main objective was to assess changes in hypertension control to <140/<90 mm Hg in younger (aged <60 years) and older adults and <150/<90 mm Hg in the latter.
National Health and Nutrition Examination Surveys (NHANES) 1988 to 1994, 1999 to 2004, and 2005 to 2010 were analyzed in adults aged ≥18 years. From 1988 to 1994 to 2005 to 2010, hypertension control to <140/<90 mm Hg improved in older (31.6% to 53.1%; P<0.001) and younger (45.7% to 55.9%; P<0.001) patients. The age gap in control declined from 14.1% (P<0.01) in 1988 to 1994 to 2.8% (P=0.13) in 2005 to 2010. Better hypertension control reflected increased percentages of older (55.6% to 77.5%) and younger (34.6% to 54.7%) patients on treatment and treated older (45.7% to 64.9%) and younger (56.8% to 73.4%) patients controlled (all P<0.001). Control to <150/<90 mm Hg rose from 48.8% to 69.9% in older adults. Antihypertensive medication number and percentages on ≥3 medications increased in both age groups but increased more in older patients (P<0.01). Blood pressure control was higher in both age groups with ≥2 healthcare visits per year and on statin therapy.
The age gap in hypertension control to <140/<90 mm Hg was virtually eliminated in 2005 to 2010 as clinicians intensified therapy, especially in older patients in whom isolated systolic hypertension predominates, controlling 70% to <150/<90 mm Hg. More frequent healthcare visits and the use of statin therapy may improve hypertension control in all adults.
联合国家委员会（Joint National Committee）制定的目标血压为，所有成年人的血压应低于 140/90mmHg，该目标从 1984 年持续至 2013 年。年龄在 60 岁及以上的成年人主要患有单纯收缩期高血压，而主要的临床试验均将收缩压目标值设定为<150mmHg，但未设定<140mmHg。本研究的主要目的是评估在年龄<60 岁的年轻成年人和年龄≥60 岁的老年人中，将高血压控制到<140/90mmHg 和<150/90mmHg 的情况。
本研究分析了 1988 年至 1994 年、1999 年至 2004 年以及 2005 年至 2010 年期间年龄≥18 岁的成年人的国家健康与营养调查（National Health and Nutrition Examination Surveys，NHANES）数据。从 1988 年至 1994 年到 2005 年至 2010 年，年龄≥60 岁和年龄<60 岁的成年人的高血压控制情况得到了改善，血压控制率分别从 31.6%提高至 53.1%（P<0.001）和从 45.7%提高至 55.9%（P<0.001）。控制率的年龄差距从 1988 年至 1994 年的 14.1%缩小至 2005 年至 2010 年的 2.8%（P=0.13）。更好的高血压控制反映了更多的年龄≥60 岁（55.6%提高至 77.5%）和年龄<60 岁（34.6%提高至 54.7%）的患者接受了治疗，且更多的年龄≥60 岁（45.7%提高至 64.9%）和年龄<60 岁（56.8%提高至 73.4%）的患者血压得到了控制（均 P<0.001）。年龄≥60 岁的成年人的血压控制率从 48.8%提高至 69.9%。两组患者的抗高血压药物种类和使用≥3 种药物的比例均有所增加，但年龄较大的患者增加更为明显（P<0.01）。每年就诊≥2 次和使用他汀类药物的患者血压控制情况更好。
到 2005 年至 2010 年，医生加强了治疗，尤其是在单纯收缩期高血压占主导地位的老年患者中，将收缩压控制在<150mmHg 的比例达到了 70%，使得年龄<60 岁和年龄≥60 岁的成年人之间的高血压控制的年龄差距几乎消失。更频繁的就诊和他汀类药物的使用可能会改善所有成年人的高血压控制情况。
