Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
J Am Coll Cardiol. 2018 Sep 11;72(11):1187-1197. doi: 10.1016/j.jacc.2018.05.074.
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline provides updated recommendations for antihypertensive medication initiation and intensification.
Determine the risk for cardiovascular disease (CVD) events among adults recommended and not recommended antihypertensive medication initiation or intensification by the 2017 ACC/AHA BP guideline.
The authors analyzed data for black and white REGARDS (REasons for Geographic And Racial Differences in Stroke) study participants (age ≥45 years). Systolic BP (SBP) and diastolic BP (DBP) were measured twice at baseline (2003 to 2007) and averaged. Participants not taking (n = 14,039) and taking (n = 15,179) antihypertensive medication were categorized according to their recommendations for antihypertensive medication initiation and intensification by the 2017 ACC/AHA guideline. Overall, 4,094 CVD events (stroke, coronary heart disease, and heart failure) occurred by December 31, 2014.
Among participants not taking antihypertensive medication, 34.4% were recommended pharmacological antihypertensive treatment initiation. The CVD event rate per 1,000 person-years among participants recommended antihypertensive medication initiation with SBP/DBP ≥140/90 mm Hg was 22.7 (95% confidence interval [CI]: 20.3 to 25.0). Among participants with SBP/DBP 130 to 139/80 to 89 mm Hg, the CVD event rate was 20.5 (95% CI: 18.5 to 22.6) and 3.4 (95% CI: 2.4 to 4.4) for those recommended and not recommended antihypertensive medication initiation, respectively. Among participants taking antihypertensive medication, 62.8% were recommended treatment intensification. The CVD event rate per 1,000 person-years among participants recommended treatment intensification was 33.6 (95% CI: 31.5 to 35.6) and 22.4 (95% CI: 20.8 to 23.9) for those with SBP/DBP ≥140/90 mm Hg and 130 to 139/80 to 89 mm Hg, respectively.
Implementing the 2017 ACC/AHA guideline would direct antihypertensive medication initiation and intensification to adults with high CVD risk.
2017 年美国心脏病学会/美国心脏协会（ACC/AHA）血压（BP）指南为抗高血压药物的起始和强化治疗提供了更新的建议。
确定 2017 年 ACC/AHA BP 指南建议和不建议抗高血压药物起始或强化治疗的成年人发生心血管疾病（CVD）事件的风险。
作者分析了 REGARDS（地理和种族差异导致中风的原因）研究中黑人和白人参与者的数据（年龄≥45 岁）。收缩压（SBP）和舒张压（DBP）在基线时测量两次（2003 年至 2007 年）并取平均值。根据 2017 年 ACC/AHA 指南，未服用（n=14039）和服用（n=15179）抗高血压药物的参与者根据其抗高血压药物起始和强化治疗的建议进行分类。截至 2014 年 12 月 31 日，共有 4094 例 CVD 事件（中风、冠心病和心力衰竭）发生。
在未服用抗高血压药物的参与者中，34.4%被建议进行药物降压治疗。SBP/DBP≥140/90mmHg 的参与者中，推荐起始抗高血压药物治疗的 CVD 事件发生率为每 1000 人年 22.7（95%置信区间[CI]：20.3 至 25.0）。在 SBP/DBP 为 130 至 139/80 至 89mmHg 的参与者中，CVD 事件发生率分别为 20.5（95%CI：18.5 至 22.6）和 3.4（95%CI：2.4 至 4.4），分别为推荐起始和不推荐起始抗高血压药物治疗的参与者。在服用抗高血压药物的参与者中，62.8%被建议进行治疗强化。推荐强化治疗的参与者的 CVD 事件发生率为每 1000 人年 33.6（95%CI：31.5 至 35.6）和 22.4（95%CI：20.8 至 23.9），分别为 SBP/DBP≥140/90mmHg 和 130 至 139/80 至 89mmHg 的参与者。
实施 2017 年 ACC/AHA 指南将指导具有高 CVD 风险的成年人开始和强化抗高血压药物治疗。
