Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada.
JAMA Netw Open. 2019 Mar 1;2(3):e190406. doi: 10.1001/jamanetworkopen.2019.0406.
The 2017 American College of Cardiology and American Heart Association (ACC/AHA) blood pressure (BP) guidelines redefined hypertension using a BP threshold of 130/80 mm Hg or greater and applied a treatment target of less than 130/80 mm Hg.
To evaluate the potential change in the diagnosis, treatment, and control of hypertension in a Canadian cohort of patients with hypertension attending primary care practices using the ACC/AHA guidelines.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used primary care practices across Canada electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network, extracted as of June 30, 2015. Adults with at least 1 primary care encounter in the previous 2 years (July 1, 2013, to June 30, 2015) were included in the study. Those with current hypertension were identified using a validated definition consisting of diagnoses, billing codes, and/or antihypertensive medication from within the primary care electronic medical record. Data analysis was conducted from December 2017 to July 2018.
Proportion of individuals with a diagnosis of hypertension, prescribed antihypertensive medication, and meeting treatment BP targets.
Of the 594 492 Canadian participants included in the study, 144 348 (24.2%) had hypertension (45.6% male; mean [SD] age, 65.5 [14.5] years). On applying the ACC/AHA guidelines, 252 279 individuals (42.4%) were considered hypertensive and half (51.0%; 95% CI, 50.8%-51.2%) were prescribed an antihypertensive medication. Individuals who were not previously considered to have hypertension but were reclassified as having elevated BP using the lower cutoff of 130/80 mm Hg or greater tended to be younger and were at lower cardiovascular risk. There was a shift toward more individuals requiring antihypertensive treatment, particularly in the lower-risk categories. The crude prevalence of hypertension increased from 13.3% to 32.0% in those aged 18 to 64 years, and of those aged 65 years and older, 16.6% more individuals were reclassified as having hypertension (from 55.2% to 71.8%). Only 12.3% of those who were considered at high risk were reclassified as hypertensive.
Adoption of the ACC/AHA BP guidelines would result in a near doubling in the prevalence of hypertension in Canada. The changes would largely affect individuals who are younger and at low to moderate cardiovascular risk.
2017 年美国心脏病学会/美国心脏协会（ACC/AHA）血压（BP）指南使用 130/80mmHg 或更高的 BP 阈值重新定义了高血压，并将治疗目标定为低于 130/80mmHg。
使用 ACC/AHA 指南评估加拿大高血压患者初级保健实践中高血压的诊断、治疗和控制的潜在变化。
设计、地点和参与者：这是一项使用加拿大初级保健监测网络（Canadian Primary Care Sentinel Surveillance Network）的加拿大初级保健实践电子病历数据的横断面研究，数据提取时间截至 2015 年 6 月 30 日。在过去 2 年中至少有 1 次初级保健就诊的成年人（2013 年 7 月 1 日至 2015 年 6 月 30 日）被纳入研究。使用由初级保健电子病历中的诊断、计费代码和/或降压药物组成的验证定义确定当前患有高血压的患者。数据分析于 2017 年 12 月至 2018 年 7 月进行。
诊断为高血压、开处方降压药物和达到治疗 BP 目标的个体的比例。
在研究纳入的 594492 名加拿大参与者中，144348 人（45.6%为男性；平均[SD]年龄 65.5[14.5]岁）患有高血压。根据 ACC/AHA 指南，252279 人（42.4%）被认为患有高血压，其中一半（51.0%；95%CI，50.8%-51.2%）开了降压药。以前没有被认为患有高血压但使用 130/80mmHg 或更高的较低切点重新分类为血压升高的个体往往更年轻，心血管风险较低。需要降压治疗的个体数量有所增加，尤其是在风险较低的类别中。18 至 64 岁人群中高血压的粗患病率从 13.3%上升至 32.0%，65 岁及以上人群中，更多的人（从 55.2%至 71.8%）被重新归类为患有高血压。只有 12.3%的高危人群被重新归类为高血压。
采用 ACC/AHA BP 指南将使加拿大的高血压患病率几乎翻一番。这些变化主要影响到年轻且处于低至中度心血管风险的人群。
