The Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University, Hangzhou, Zhejiang, China.
Department of Physiology, University of Toronto, Toronto, Ontario, Canada.
Am J Hypertens. 2020 Sep 10;33(9):846-851. doi: 10.1093/ajh/hpaa094.
The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) (US) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults expanded the definition of hypertension and now considers atherosclerotic cardiovascular disease (ASCVD) risk in determining treatment for people with hypertension. US guidelines are influential around the world and it is therefore justified to study their impact in other settings. Our study determined the impact of adopting the 2017 ACC/AHA guideline in China.
We analyzed the population impact of the 2017 ACC/AHA guideline using the 2011-2012 year of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative sample of Chinese adults 45-74 years of age (n = 11,822). Our analysis was unique because for the first time it used a population-appropriate equation to calculate ASCVD risk instead of the US Pooled Cohort Equation (the latter misrepresents risk in non-US populations).
Adopting the 2017 ACC/AHA guideline in China would increase the prevalence of hypertension from 44.1% to 56.4% (12.3 percentage points) and increase the number of adults recommended for antihypertensive medication from 41.6% to 49.1% (7.5 percentage points) in the 45-74-year age range. According to Chinese (but not US) risk calculations, the 2017 ACC/AHA guideline more selectively assigns antihypertensive medication to patients at higher risk for ASCVD.
The 2017 ACC/AHA guideline brings potential for risk reduction in China and selectively recommends medication for those who would benefit most. Realizing such benefits would ultimately depend on the acceptance, adherence, and feasibility of adopting this guideline.
2017 年美国心脏病学会（ACC）/美国心脏协会（AHA）（美国）高血压防治、检测、评估和管理指南扩大了高血压的定义，现在将动脉粥样硬化性心血管疾病（ASCVD）风险纳入高血压患者的治疗决策中。美国的指南在全球范围内具有影响力，因此有理由研究其在其他环境中的影响。我们的研究旨在确定在中国采用 2017 年 ACC/AHA 指南的影响。
我们使用中国健康与退休纵向研究（CHARLS）2011-2012 年的数据（一个具有全国代表性的中国 45-74 岁成年人样本，n=11822）分析了 2017 年 ACC/AHA 指南的人群影响。我们的分析是独特的，因为它首次使用适合人群的方程来计算 ASCVD 风险，而不是美国的汇总队列方程（后者在非美国人群中错误地代表风险）。
在中国采用 2017 年 ACC/AHA 指南将使高血压的患病率从 44.1%增加到 56.4%（12.3 个百分点），并使 45-74 岁年龄组中建议使用降压药物的成年人人数从 41.6%增加到 49.1%（7.5 个百分点）。根据中国（而非美国）的风险计算，2017 年 ACC/AHA 指南更有选择性地将降压药物分配给 ASCVD 风险较高的患者。
2017 年 ACC/AHA 指南在中国具有降低风险的潜力，并为那些最受益的患者有选择性地推荐药物。实现这些益处最终将取决于接受、遵守和实施这一指南的能力。
