Department of Noncommunicable Diseases, Bangladesh University of Health Sciences, 125/1 Darus Salam, Mirpur-1, Dhaka-1216, Bangladesh.
Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences, 125/1 Darus Salam, Mirpur-1, Dhaka-1216, Bangladesh.
Medicina (Kaunas). 2019 Jun 26;55(7):315. doi: 10.3390/medicina55070315.
Justification for application of 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines to detect hypertension (HTN) among Bangladeshi population is understudied. This prompted us to examine the level of agreement between 2017 ACC/AHA and Joint National Committee 7 (JNC 7) guidelines to detect postmenopausal HTN in a rural area of Bangladesh. This cross-sectional study recruited 265 postmenopausal women of 40-70 years of age who visited a rural primary health care centre of Bangladesh. HTN was diagnosed based on two definitions: the JNC 7 guidelines (SBP ≥ 140 or DBP ≥ 90 mmHg), and the 2017 ACC/AHA guidelines (SBP ≥ 130 mmHg, or DBP ≥ 80 mmHg). The prevalence of postmenopausal HTN, its sub-types and stages were reported and compared using frequency and percentage. Agreement was evaluated using Cohen's Kappa (κ), Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) and First-order Agreement Coefficient (AC1). The prevalence of postmenopausal HTN was 67.5% and 41.9% using 2017 ACC/AHA and JNC 7 guidelines respectively. Among the HTN sub-types and stages, the new 2017 ACC/AHA guideline classified higher proportion of respondents as having isolated systolic hypertension (ISH) (42.6%) and stage 2 HTN (35.8%) compared to JNC 7 (28.7% and 6.8% respectively). On the other hand, the JNC 7 guideline identified more respondents as pre-hypertensive (32.5%) when compared with the 2017 ACC/AHA guideline (3.8%). Between two guidelines, highest agreement was observed for ISH (86.03%) and those had pre-hypertension/elevated blood pressure (71.3%). Similarly, Landis & Koch's approach detected highest agreement for ISH (κ = 0.74, substantial; PABAK = 0.76, substantial; AC1 = 0.84, excellent; p < 0.001) and pre-hypertension/elevated blood pressure (κ= 0.12, slight; PABAK = 0.42, moderate; AC1 = 0.83, excellent; p < 0.001). The 2017 ACC/AHA HTN guideline reported high agreement and detected more participants as hypertensive when compared with JNC 7 guideline for Bangladeshi postmenopausal women that demands further large-scale study in general population to clarify the current findings more precisely.
在孟加拉国人群中应用 2017 年美国心脏病学会/美国心脏协会 (ACC/AHA) 指南来检测高血压 (HTN) 的依据尚不清楚。这促使我们在孟加拉国一个农村地区研究 2017 年 ACC/AHA 和联合国家委员会 7 (JNC 7) 指南检测绝经后 HTN 的一致性水平。这项横断面研究招募了 265 名年龄在 40-70 岁的绝经后妇女，她们访问了孟加拉国的一个农村初级保健中心。高血压的诊断依据是两种定义：JNC 7 指南（SBP≥140 或 DBP≥90mmHg）和 2017 年 ACC/AHA 指南（SBP≥130mmHg 或 DBP≥80mmHg）。使用频率和百分比报告并比较了绝经后 HTN 的患病率、其亚型和阶段。使用 Cohen's Kappa (κ)、Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) 和 First-order Agreement Coefficient (AC1) 评估一致性。使用 2017 年 ACC/AHA 和 JNC 7 指南，绝经后 HTN 的患病率分别为 67.5%和 41.9%。在高血压亚型和阶段中，与 JNC 7 相比，新的 2017 年 ACC/AHA 指南将更高比例的患者归类为单纯收缩期高血压 (ISH)（42.6%）和 2 期高血压（35.8%）。另一方面，与 2017 年 ACC/AHA 指南（3.8%）相比，JNC 7 指南将更多的患者归类为高血压前期/血压升高（32.5%）。在两种指南之间，ISH 观察到最高的一致性（86.03%）和那些有高血压前期/血压升高的一致性（71.3%）。同样，Landis & Koch 的方法检测到 ISH（κ=0.74，中度；PABAK=0.76，中度；AC1=0.84，优秀；p<0.001）和高血压前期/血压升高（κ=0.12，轻度；PABAK=0.42，中度；AC1=0.83，优秀；p<0.001）的最高一致性。与 JNC 7 指南相比，2017 年 ACC/AHA 高血压指南对孟加拉国绝经后妇女的高血压报告有较高的一致性，并检测到更多的患者为高血压，这需要在一般人群中进行进一步的大规模研究，以更准确地阐明目前的发现。
