Chowdhury Enayet Karim, Ernst Michael E, Nelson Mark, Margolis Karen, Beilin Lawrie J, Johnston Collin, Woods Robyn, Murray Anne, Wolfe Rory, Storey Elsdon, Shah Raj C, Lockery Jessica, Tonkin Andrew, Newman Anne, Abhayaratna Walter, Stocks Nigel, Fitzgerald Sharyn, Orchard Suzanne, Trevaks Ruth, Donnan Geoffrey, Grimm R, McNeil John, Reid Christopher M
Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria.
School of Public Health, Curtin University, Perth, Western Australia, Australia.
J Hypertens. 2020 Dec;38(12):2527-2536. doi: 10.1097/HJH.0000000000002582.
The AHA/ACC-2017 hypertension guideline recommends an age-independent target blood pressure (BP) of less than 130/80 mmHg. In an elderly cohort without established cardiovascular disease (CVD) at baseline, we determined the impact of this guideline on the prevalence of hypertension and associated CVD risk.
Nineteen thousand, one hundred and fourteen participants aged at least 65 years from the ASPirin in Reducing Events in the Elderly (ASPREE) study were grouped by baseline BP: 'pre-2017 hypertensive' (BP ≥140/90 mmHg and/or on antihypertensive drugs); 'reclassified hypertensive' (normotensive by pre-2017 guidelines; hypertensive by AHA/ACC-2017 guideline), and 'normotensive' (BP <130 and <80 mmHg). For each group, we evaluated CVD risk factors, predicted 10-year CVD risk using the Atherosclerotic Cardiovascular Disease (ASCVD) risk equation, and reported observed CVD event rates during a median 4.7-year follow-up.
Overall, 74.4% (14 213/19 114) were 'pre-2017 hypertensive'; an additional 12.3% (2354/19 114) were 'reclassified hypertensive' by the AHA/ACC-2017 guideline. Of those 'reclassified hypertensive', the majority (94.5%) met criteria for antihypertensive treatment although 29% had no other traditional CVD risk factors other than age. Further, a relatively lower mean 10-year predicted CVD risk (18% versus 26%, P < 0.001) and lower CVD rates (8.9 versus 12.1/1000 person-years, P = 0.01) were observed in 'reclassified hypertensive' compared with 'pre-2017 hypertensive'. Compared with 'normotensive', a hazard ratio (95% confidence interval) for CVD events of 1.60 (1.26-2.02) for 'pre-2017 hypertensive' and 1.26 (0.93-1.71) for 'reclassified hypertensive' was observed.
Applying current CVD risk calculators in the elderly 'reclassified hypertensive', as a result of shifting the BP threshold lower, increases eligibility for antihypertensive treatment but documented CVD rates remain lower than hypertensive patients defined by pre2017 BP thresholds.
美国心脏协会/美国心脏病学会2017年高血压指南推荐将血压目标设定为低于130/80 mmHg，不受年龄影响。在一个基线时无已确诊心血管疾病（CVD）的老年队列中，我们确定了该指南对高血压患病率及相关CVD风险的影响。
阿司匹林用于减少老年人事件（ASPREE）研究中19114名年龄至少65岁的参与者按基线血压分组：“2017年前高血压患者”（血压≥140/90 mmHg和/或正在服用降压药）；“重新分类的高血压患者”（按照2017年前指南为血压正常；按照美国心脏协会/美国心脏病学会2017年指南为高血压），以及“血压正常者”（血压<130和<80 mmHg）。对于每组，我们评估了CVD危险因素，使用动脉粥样硬化性心血管疾病（ASCVD）风险方程预测10年CVD风险，并报告了在中位4.7年随访期间观察到的CVD事件发生率。
总体而言，74.4%（14213/19114）为“2017年前高血压患者”；另有12.3%（2354/19114）按照美国心脏协会/美国心脏病学会2017年指南被“重新分类为高血压患者”。在那些“重新分类的高血压患者”中，大多数（94.5%）符合降压治疗标准，尽管29%除年龄外没有其他传统CVD危险因素。此外，与“2017年前高血压患者”相比，“重新分类的高血压患者”观察到相对较低的平均10年预测CVD风险（18%对26%，P<0.001）和较低的CVD发生率（8.9对12.1/1000人年，P = 0.01）。与“血压正常者”相比，“2017年前高血压患者”CVD事件的风险比（95%置信区间）为1.60（1.26 - 2.02），“重新分类的高血压患者”为1.26（0.93 - 1.71）。
由于降低了血压阈值，在老年“重新分类的高血压患者”中应用当前的CVD风险计算器增加了降压治疗的适用率，但记录的CVD发生率仍低于按照2017年前血压阈值定义的高血压患者。
