Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75219, USA.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT 06510, USA.
BMJ. 2018 Jul 11;362:k2357. doi: 10.1136/bmj.k2357.
To examine the effect of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines on the prevalence of hypertension and eligibility for initiation and intensification of treatment in nationally representative populations from the United States and China.
Observational assessment of nationally representative data.
US National Health and Nutrition Examination Survey (NHANES) for the most recent two cycles (2013-14, 2015-16) and China Health and Retirement Longitudinal Study (CHARLS) (2011-12).
All 45-75 year old adults who would have a diagnosis of hypertension and be candidates for treatment on the basis of the ACC/AHA guidelines, compared with current guidelines.
Diagnosis of hypertension and candidacy for initiation and intensification of antihypertensive treatment.
Adoption of the 2017 ACC/AHA hypertension guidelines in the US would label 70.1 (95% confidence interval 64.9 to 75.3) million people in the 45-75 year age group as having hypertension, representing 63% (60.6% to 65.4%) of the population in this age group. Their adoption in China would lead to labeling of 266.9 (252.9 to 280.8) million people or 55% (53.4% to 56.7%) of the same age group as having hypertension. This would represent an increase in prevalence of 26.8% (23.2% to 30.9%) in the US and 45.1% (41.3% to 48.9%) in China. Furthermore, on the basis of treatment patterns and current guidelines, 8.1 (6.5 to 9.7) million Americans with hypertension are untreated, which would be expected to increase to 15.6 (13.6 to 17.7) million after the implementation of the ACC/AHA guidelines. In China, on the basis of current treatment patterns, 74.5 (64.1 to 84.8) million patients with hypertension are untreated, estimated to increase to 129.8 (118.7 to 140.9 million. In addition, the ACC/AHA guidelines would label 8.7 (6.0 to 11.5) million adults in the US and 51 (40.3 to 61.6) million in China as having hypertension that would not require antihypertensive treatment, compared with 1.5 (1.2 to 2.1) million and 23.4 (12.1 to 35.1) million with the current guidelines. Finally, even among people receiving treatment, the proportion that are candidates for intensification of treatment is estimated to increase by 13.9 (12.2 to 15.6) million (from 24.0% to 54.4% of treated patients) in the US, and 30 (24.3 to 35.7) million (41.4% to 76.2% of treated patients) in China, if the ACC/AHA treatment targets are adopted.
If adopted, the 2017 ACC/AHA hypertension guidelines will markedly increase the number of people labeled as having hypertension and treated with drugs in both the US and China, leading to more than half of those aged 45-75 years in both countries being considered hypertensive.
研究 2017 年美国心脏病学会（ACC）/美国心脏协会（AHA）高血压指南对美国和中国具有代表性的人群中高血压的流行率及起始和强化治疗的适宜性的影响。
对具有代表性的全国性数据进行观察性评估。
美国国家健康和营养调查（NHANES）最近两个周期（2013-14 年、2015-16 年）和中国健康与退休纵向研究（CHARLS）（2011-12 年）。
所有年龄在 45-75 岁之间、根据 ACC/AHA 指南将被诊断为高血压并可能接受治疗的成年人，与现行指南相比。
高血压的诊断以及起始和强化降压治疗的适应证。
如果在美国采用 2017 年 ACC/AHA 高血压指南，45-75 岁年龄组将有 7010 万人（95%置信区间为 6490 万至 7530 万）被诊断为高血压，占该年龄组人口的 63%（60.6%至 65.4%）。如果在中国采用该指南，将有 2.669 亿人（2.529 亿至 2.808 亿）或相同年龄组的 55%（53.4%至 56.7%）被标记为患有高血压。这将使美国的高血压患病率增加 26.8%（23.2%至 30.9%），中国的高血压患病率增加 45.1%（41.3%至 48.9%）。此外，根据治疗模式和现行指南，美国有 810 万人（6.5 至 9.7）高血压未得到治疗，预计在实施 ACC/AHA 指南后，这一数字将增加到 1560 万人（1360 万至 1770 万）。在中国，根据现行的治疗模式，有 7450 万人（6410 万至 8480 万）高血压患者未得到治疗，预计将增加到 12980 万人（11870 万至 14090 万）。此外，ACC/AHA 指南将有 870 万人（6.0 至 11.5）在美国和 5100 万人（4030 万至 6160 万）在中国被标记为患有不需要降压治疗的高血压，而根据现行指南，这一数字分别为 150 万人（120 万至 210 万）和 2340 万人（1210 万至 3510 万）。最后，即使在接受治疗的人群中，据估计，美国有 1390 万人（24.0%至 54.4%的治疗患者）和中国有 3000 万人（41.4%至 76.2%的治疗患者）将成为强化治疗的候选者，如果采用 ACC/AHA 的治疗目标。
如果采用 2017 年 ACC/AHA 高血压指南，将显著增加美国和中国被标记为患有高血压并接受药物治疗的人数，两国 45-75 岁年龄段的人群中，将有一半以上被认为患有高血压。
