Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP).
Madrid Health Service, Centro de Salud Universitario Cerro del Aire, Madrid.
J Hypertens. 2019 Jul;37(7):1393-1400. doi: 10.1097/HJH.0000000000002065.
Unlike the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guideline, the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline has recommended a shift in hypertension definition from blood pressure (BP) 140/90-130/80 mmHg. Further, they proposed somewhat different indications for antihypertensive medication. No data are available on the comprehensive impact of these guidelines in European countries, where physicians do not always follow guidelines from their own continent. We estimated the prevalence of hypertension, recommendations for antihypertensive medication, and cardiometabolic goals achieved in Spain using the ESC/ESH versus ACC/AHA guidelines.
We analyzed data from a national survey on 12074 individuals representative of the population aged at least 18 years in Spain. BP was measured with standardized procedures.
According to the ESC/ESH and ACC/AHA guidelines, hypertension prevalence was 33.1% (95% confidence interval: 32.2-33.9%) and 46.9% (46.0-47.8%), respectively, and antihypertensive medication was recommended for 33.5% (32.7-34.3%) and 37.2% (36.3-38.1%) of adults, respectively. This represents 5.3 more million hypertensive patients and 1.4 more million candidates for medication (for a 40-million-adults' country) using the ACC/AHA versus the ESC/ESH guideline. Participants who were hypertensive under the ACC/AHA but not the ESC/ESH guideline achieved less frequently some cardiometabolic goals (e.g. nonsmoking, reduced salt consumption, LDL cholesterol if hypercholesterolemic, lifestyle medical advice, and treatment with renin-angiotensin-system blockers where indicated) than those who were hypertensive under the ESC/ESH guideline.
The implementation of the ACC/AHA versus the ESC/ESH guideline would result in a substantial increase in the prevalence of hypertension and the number of adults who should receive medication. There is room for improvement in lifestyles and cardioprotective treatment in individuals with BP of 130-9/80-9 mmHg whether they are called hypertensive (ACC/AHA) or not (ESC/ESH). We suggest that clinical-practice guidelines should consider the public health and costs implications, and not only the evidence on effectiveness and cost-effectiveness, of their recommendations.
与 2018 年欧洲心脏病学会/欧洲高血压学会（ESC/ESH）指南不同，2017 年美国心脏病学会/美国心脏协会（ACC/AHA）指南建议将高血压定义从血压（BP）140/90-130/80mmHg 转变。此外，他们还提出了抗高血压药物治疗的不同指征。在欧洲国家，由于医生并不总是遵循来自自己大陆的指南，因此尚无关于这些指南综合影响的相关数据。我们使用 ESC/ESH 与 ACC/AHA 指南来估计西班牙高血压的患病率、抗高血压药物治疗的建议以及实现的心血管代谢目标。
我们分析了一项针对至少 18 岁西班牙人口的全国调查中 12074 名个体的数据。BP 通过标准化程序进行测量。
根据 ESC/ESH 和 ACC/AHA 指南，高血压患病率分别为 33.1%（95%置信区间：32.2-33.9%）和 46.9%（46.0-47.8%），分别有 33.5%（32.7-34.3%）和 37.2%（36.3-38.1%）的成年人被建议接受抗高血压药物治疗。这代表着（对于一个拥有 4000 万成年人的国家而言）使用 ACC/AHA 与 ESC/ESH 指南相比，高血压患者增加了 530 多万人，需要药物治疗的患者增加了 140 多万人。根据 ACC/AHA 患有高血压但不符合 ESC/ESH 标准的患者比符合 ESC/ESH 标准的患者更难以实现某些心血管代谢目标（例如不吸烟、减少盐的摄入、如果血脂异常则降低 LDL 胆固醇、生活方式医学建议以及在需要时使用肾素-血管紧张素系统阻滞剂治疗）。
与 ESC/ESH 相比，实施 ACC/AHA 指南将导致高血压患病率和应接受药物治疗的成年人数量大幅增加。在血压为 130-9/80-9mmHg 的人群中，无论他们是否被称为高血压（ACC/AHA），都有改善生活方式和心脏保护治疗的空间（ESC/ESH）。我们建议临床实践指南应考虑其建议对公共卫生和成本的影响，而不仅仅是对有效性和成本效益的证据。
