St. John's University, Queens, NY.
CUNY Baruch College, New York, NY.
Am J Med. 2018 Nov;131(11):1349-1358.e5. doi: 10.1016/j.amjmed.2018.06.030. Epub 2018 Jul 26.
The 2017 American College of Cardiology/American Heart Association Guideline introduced new categories of high blood pressure. The vast majority of individuals in these newly defined categories are recommended for nonpharmacological intervention rather than antihypertensive therapy. This study sought to determine the burden of potentially modifiable risk factors of hypertension among untreated adults in the newly defined categories of blood pressure.
We analyzed data from the 1999-2014 National Health and Nutrition Examination Survey (N = 37,448). Potentially modifiable risk factors included abdominal obesity, high non-high-density lipoprotein (HDL) cholesterol, secondhand smoking, binge drinking, suboptimal physical activity, and low-fiber diet.
Although the prevalence of certain modifiable risk factors decreased during the study period, the prevalence of low fiber intake, suboptimal physical activity, abdominal obesity, and binge drinking remained high during the last combined survey cycle (2011-2014). Modifiable risk factors generally demonstrated dose-response relationships with high blood pressure categories. The most common type of risk factor clustering included low fiber intake, suboptimal physical activity, high non-HDL cholesterol, and abdominal obesity, with its prevalence increasing gradually from 9.5% (95% confidence interval, 8.8%-10.3%) in the normal blood pressure group to 16.5% (95% confidence interval, 14.8%-18.3%) in the stage 2 hypertension group (P < .001). The prevalence of 4 or more modifiable risk factors per participant increased stepwise, ranging from 28.5% in the normal blood pressure group to 48.0% in the stage 2 hypertension group (P < .001).
The burden of potentially modifiable risk factors for hypertension shows progressive increase along the blood pressure categories and represents an important target for nonpharmacologic intervention.
2017 年美国心脏病学会/美国心脏协会指南引入了新的高血压分类。这些新定义类别中的绝大多数患者被建议进行非药物干预，而不是降压治疗。本研究旨在确定新定义的血压类别中未经治疗的成年人中高血压的潜在可改变危险因素的负担。
我们分析了 1999-2014 年全国健康和营养检查调查（N=37448）的数据。潜在可改变的危险因素包括腹部肥胖、非高密度脂蛋白（HDL）胆固醇升高、二手烟、狂饮、身体活动不足和低纤维饮食。
尽管在研究期间某些可改变的危险因素的患病率有所下降，但在最后一次联合调查周期（2011-2014 年）期间，低纤维摄入、身体活动不足、腹部肥胖和狂饮的患病率仍然很高。可改变的危险因素通常与高血压类别呈剂量反应关系。最常见的风险因素聚类类型包括低纤维摄入、身体活动不足、非高密度脂蛋白胆固醇升高和腹部肥胖，其患病率从正常血压组的 9.5%（95%置信区间，8.8%-10.3%）逐渐增加到 2 期高血压组的 16.5%（95%置信区间，14.8%-18.3%）（P<0.001）。每个参与者中 4 个或更多可改变的危险因素的患病率逐渐增加，从正常血压组的 28.5%到 2 期高血压组的 48.0%（P<0.001）。
高血压的潜在可改变危险因素的负担随着血压类别的增加而呈渐进性增加，这代表了非药物干预的重要目标。
