Marques-Vidal Pedro, Waeber Gérard, Waeber Bernard, Vollenweider Peter
aDepartment of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine bDivision of Clinical Pathophysiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
J Hypertens. 2015 Apr;33(4):868-73. doi: 10.1097/HJH.0000000000000466.
To evaluate the population and economic impact of implementing the new Joint National Committee (JNC) or European Society of Hypertension (ESH)/European Society of Cardiology (ESC) hypertension guidelines in the Swiss population.
Cross-sectional, population-based sample (6708 participants) collected between 2003 and 2006 in the city of Lausanne, Switzerland. Blood pressure categories were defined according to both the JNC (JNC-7 and JNC-8) and the ESH/ESC (2007 and 2013) guidelines.
The proportion of participants aged 35-60 years eligible for drug treatment was 25.6% [95% confidence interval (CI) 24.4-26.9%] and 24.8% (95% CI 23.6-26.0%) for the JNC-7 and the JNC-8 guidelines, respectively; for participants aged 60-75 years, the values were 62.3% (95% CI 60.1-64.5%) and 46.8% (95% CI 44.5-49.0%), respectively. Shifting from the JNC-7 to the JNC-8 guidelines would lead to an annual saving of 163.6 million Swiss francs (187.7 million US dollars or 134.5 million European €). The proportion of participants aged 35-75 years without chronic kidney disease, diabetes mellitus or reported history of cardiovascular disease and eligible for treatment was 30.2% (95% CI 29.0-31.4%) for the ESH/ESC 2007 and 2013 guidelines. For participants with chronic kidney disease, diabetes mellitus or reported history of cardiovascular disease, the values were 73.6% (95% CI 70.8-76.3%) and 55.6% (95% CI 52.5-58.8%), respectively. Shifting from the ESH/ESC 2007 to the ESH/ESC 2013 guidelines would lead to an annual saving of 86.9 million Swiss francs (99.5 million US dollars or 71.4 million European €).
In Switzerland, shifting from the JNC-7 to the JNC-8 guidelines or from the ESH/ESC 2007 to the ESH/ESC 2013 guidelines would decrease the prevalence of patients eligible for treatment and increase the percentage of treated patients within blood pressure goals. Both strategies lead to potential savings in antihypertensive drug treatment.
评估在瑞士人群中实施新的美国国家联合委员会（JNC）或欧洲高血压学会（ESH）/欧洲心脏病学会（ESC）高血压指南对人群和经济的影响。
于2003年至2006年在瑞士洛桑市收集基于人群的横断面样本（6708名参与者）。血压类别根据JNC（JNC - 7和JNC - 8）以及ESH/ESC（2007年和2013年）指南进行定义。
对于年龄在35 - 60岁符合药物治疗条件的参与者，根据JNC - 7和JNC - 8指南，比例分别为25.6%[95%置信区间（CI）24.4 - 26.9%]和24.8%（95%CI 23.6 - 26.0%）；对于年龄在60 - 75岁的参与者，相应数值分别为62.3%（95%CI 60.1 - 64.5%）和46.8%（95%CI 44.5 - 49.0%）。从JNC - 7指南转变为JNC - 8指南将导致每年节省1.636亿瑞士法郎（1.877亿美元或1.345亿欧元）。对于年龄在35 - 75岁且无慢性肾病、糖尿病或心血管疾病报告史且符合治疗条件的参与者，根据ESH/ESC 2007年和2013年指南，比例为30.2%（95%CI 29.0 - 31.4%）。对于患有慢性肾病、糖尿病或有心血管疾病报告史的参与者，相应数值分别为73.6%（95%CI 70.8 - 76.3%）和55.6%（95%CI 52.5 - 58.8%）。从ESH/ESC 2007年指南转变为ESH/ESC 2013年指南将导致每年节省8690万瑞士法郎（9950万美元或7140万欧元）。
在瑞士，从JNC - 7指南转变为JNC - 8指南或从ESH/ESC 2007年指南转变为ESH/ESC 2013年指南将降低符合治疗条件患者的患病率，并提高血压控制在目标范围内患者的比例。两种策略均能在抗高血压药物治疗方面实现潜在节省。
