深入了解伊朗高血压服务全民覆盖的血压目标：2017 年 ACC/AHA 与 JNC 8 高血压指南。
Insight into blood pressure targets for universal coverage of hypertension services in Iran: the 2017 ACC/AHA versus JNC 8 hypertension guidelines.
机构信息
National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
出版信息
BMC Public Health. 2020 Mar 17;20(1):347. doi: 10.1186/s12889-020-8450-1.
BACKGROUND
We compared the prevalence, awareness, treatment, and control of hypertension in Iran based on two hypertension guidelines; the 2017 ACC/AHA -with an aggressive blood pressure target of 130/80 mmHg- and the commonly used JNC8 guideline cut-off of 140/90 mmHg. We shed light on the implications of the 2017 ACC/AHA for population subgroups and high-risk individuals who were eligible for non-pharmacologic and pharmacologic therapies.
METHODS
Data was obtained from the Iran national STEPS 2016 study. Participants included 27,738 adults aged ≥25 years as a representative sample of Iranians. Regression models of survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension.
RESULTS
The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) based on the 2017 ACC/AHA. The percentage of awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0), respectively, by applying the 2017 ACC/AHA. Based on the new guideline, adults aged 25-34 years had the largest increase in prevalence (from 7.3 to 30.7%). They also had the lowest awareness and treatment rate, contrary to the highest control rate (36.5%) between age groups. Compared with JNC8, based on the 2017 ACC/AHA, 24, 15, 17, and 11% more individuals with dyslipidaemia, high triglycerides, diabetes, and cardiovascular disease events, respectively, fell into the hypertensive category. Yet, based on the 2017 ACC/AHA, 68.2% of individuals falling into the hypertensive category were eligible for receiving pharmacologic therapy (versus 95.7% in JNC8). LDL cholesterol< 130 mg/dL, sufficient physical activity (Metabolic Equivalents≥600/week), and Body Mass Index were found to change blood pressure by - 3.56(- 4.38, - 2.74), - 2.04(- 2.58, - 1.50), and 0.48(0.42, 0.53) mmHg, respectively.
CONCLUSIONS
Switching from JNC8 to 2017 ACC/AHA sharply increased the prevalence and drastically decreased the awareness, treatment, and control in Iran. Based on the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category; these individuals might benefit from earlier interventions such as lifestyle modifications. The low control rate among individuals receiving treatment warrants a critical review of hypertension services.
背景
我们比较了伊朗基于两种高血压指南（2017 年 ACC/AHA 指南，目标血压为 130/80mmHg，具有积极的降压目标，以及常用的 JNC8 指南，血压切点为 140/90mmHg）的高血压患病率、知晓率、治疗率和控制率。我们关注了 2017 年 ACC/AHA 指南对人群亚组和符合非药物和药物治疗标准的高危个体的影响。
方法
数据来自 2016 年伊朗全国 STEPS 研究。参与者包括 27738 名年龄≥25 岁的成年人，是伊朗人的代表性样本。使用基于调查设计的回归模型来研究高血压患病率、知晓率、治疗率和控制率的决定因素。
结果
基于 JNC8 的高血压患病率为 29.9%（95%CI：29.2-30.6），根据 2017 年 ACC/AHA 指南，患病率飙升至 53.7%（52.9-54.4）。知晓率、治疗率和控制率分别为 59.2%（58.0-60.3）、80.2%（78.9-81.4）和 39.1%（37.4-40.7）基于 JNC8，而根据 2017 年 ACC/AHA 指南，这一比例分别降至 37.1%（36.2-38.0）、71.3%（69.9-72.7）和 19.6%（18.3-21.0）。根据新指南，25-34 岁成年人的患病率增幅最大（从 7.3%增至 30.7%）。他们的知晓率和治疗率最低，而控制率最高（36.5%），在不同年龄组之间存在差异。与 JNC8 相比，基于 2017 年 ACC/AHA，分别有 24%、15%、17%和 11%的血脂异常、高甘油三酯血症、糖尿病和心血管疾病患者更多地归入高血压类别。然而，根据 2017 年 ACC/AHA，68.2%的高血压患者有资格接受药物治疗（而 JNC8 为 95.7%）。LDL 胆固醇<130mg/dL、充分的体力活动（代谢当量≥600/周）和体重指数分别使血压降低-3.56（-4.38，-2.74）、-2.04（-2.58，-1.50）和 0.48（0.42，0.53）mmHg。
结论
从 JNC8 切换到 2017 年 ACC/AHA 指南显著增加了伊朗的高血压患病率，大幅降低了知晓率、治疗率和控制率。根据 2017 年 ACC/AHA 指南，更多的年轻成年人和患有慢性合并症的人归入高血压类别；这些个体可能受益于更早的干预措施，如生活方式的改变。接受治疗的个体的低控制率需要对高血压服务进行严格审查。
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