Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA Cardiol. 2019 May 1;4(5):455-459. doi: 10.1001/jamacardio.2019.0529.
Patterns of hypertension risk development over the adult lifespan and lifetime risks for hypertension under the American Heart Association and American College of Cardiology (AHA/ACC) 2017 thresholds for hypertension (≥130/80 mm Hg) are unknown.
To quantify and compare lifetime risks for hypertension in white and African American men and women under the AHA/ACC 2017 and the Seventh Joint National Commission (JNC7) hypertension thresholds.
DESIGN, SETTING, AND PARTICIPANTS: We used individual-level pooled data from 3 contemporary cohorts in the Cardiovascular Lifetime Risk Pooling Project: the Framingham Offspring Study, the Coronary Artery Risk Development in Young Adults study, and Atherosclerosis Risk in Communities study. These community-based cohorts included white and African American men and women with blood pressure assessment at multiple cohort examinations.
Cumulative lifetime risk for hypertension from ages 20 through 85 years, adjusted for competing risk of death and baseline hypertension prevalence. Incident hypertension under the AHA/ACC threshold was defined by a single-occasion blood pressure measurement of 130/80 mm Hg or more or self-reported use of antihypertensive medications. Incident hypertension under the JNC7 threshold was defined by a single-occasion blood pressure measurement of 140/90 mm Hg or more or the use of antihypertensive medications.
A total of 13 160 participants contributed 227 600 person-years of follow-up; the data set included individual-level data on 6313 participants at baseline (median age, 25 years), plus person-year data from participants in the Atherosclerosis Risk in Communities and Framingham Offspring studies who enrolled at older ages. Baseline prevalence of hypertension under the AHA/ACC 2017 threshold in participants entering the data set between 20 and 30 years of age was 30.7% in white men (n = 549 of 1790), 23.1% in African American men (n = 245 of 1063), 10.2% in white women (n = 210 of 2070), and 12.3% in African American women (n = 171 of 1390). White men had lifetime risk of hypertension of 83.8% (95% CI, 82.5%-85.0%); African American men, 86.1% (95% CI, 84.1%-88.1%); white women, 69.3% (95% CI, 67.8%-70.7%); and African American women, 85.7% (95% CI, 84.0%-87.5%). These were greater than corresponding lifetime risks under the JNC7 threshold for hypertension (white men, 60.5% [95% CI, 58.9%-62.1%]; African American men, 74.7% [95% CI, 71.9%-77.5%]; white women, 53.9% [95% CI, 52.5%-55.4%]; and African American women, 77.3% [95% CI, 75.0%-79.5%]).
Under the AHA/ACC 2017 blood pressure threshold for hypertension, lifetime risks for hypertension exceeded 75% for African American men and women and white men. Furthermore, prevalence of blood pressure of 130/80 mm Hg or more is very high in young adulthood, suggesting that efforts to prevent development of hypertension should be focused early in the life course.
重要性：目前尚不清楚美国心脏协会/美国心脏病学会（AHA/ACC）2017 年高血压阈值（≥130/80mmHg）下成年期高血压风险发展模式和高血压终生风险。
目的：根据 AHA/ACC 2017 年和第七联合国家委员会（JNC7）高血压阈值，量化和比较白人和非裔美国人男性和女性的高血压终生风险。
设计、设置和参与者：我们使用心血管终生风险汇集项目中 3 个当代队列的个体水平汇总数据：弗雷明汉后代研究、年轻人冠状动脉风险发展研究和社区动脉粥样硬化风险研究。这些基于社区的队列包括在多次队列检查中有血压评估的白人和非裔美国男性和女性。
主要结果和措施：从 20 岁到 85 岁的高血压终生风险，调整了死亡的竞争风险和基线高血压患病率。根据 AHA/ACC 阈值，高血压的发生是通过单次血压测量≥130/80mmHg 或使用抗高血压药物来定义的。根据 JNC7 阈值，高血压的发生是通过单次血压测量≥140/90mmHg 或使用抗高血压药物来定义的。
结果：共有 13600 名参与者提供了 227600 人年的随访数据；该数据集包括基线时（中位年龄 25 岁）6313 名参与者的个体水平数据，以及在动脉粥样硬化风险社区和弗雷明汉后代研究中年龄较大时入组的参与者的人年数据。在 20 至 30 岁之间入组的数据集中，白人男性中 AHA/ACC 2017 年高血压阈值的基线高血压患病率为 30.7%（n=1790 中 549 人），非裔美国男性为 23.1%（n=1063 中 245 人），白人女性为 10.2%（n=2070 中 210 人），非裔美国女性为 12.3%（n=1390 中 171 人）。白人男性高血压终生风险为 83.8%（95%CI，82.5%-85.0%）；非裔美国男性为 86.1%（95%CI，84.1%-88.1%）；白人女性为 69.3%（95%CI，67.8%-70.7%）；非裔美国女性为 85.7%（95%CI，84.0%-87.5%）。这些风险高于根据 JNC7 高血压阈值的相应终生风险（白人男性为 60.5%[95%CI，58.9%-62.1%]；非裔美国男性为 74.7%[95%CI，71.9%-77.5%]；白人女性为 53.9%[95%CI，52.5%-55.4%]；非裔美国女性为 77.3%[95%CI，75.0%-79.5%]）。
结论和相关性：根据 AHA/ACC 2017 年高血压血压阈值，非裔美国男性和女性以及白人男性的高血压终生风险超过 75%。此外，130/80mmHg 或更高的血压在年轻成年期非常普遍，这表明应在生命早期集中精力预防高血压的发展。
