Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Am J Hypertens. 2021 Jun 22;34(6):591-599. doi: 10.1093/ajh/hpaa206.
2014 hypertension guidelines raised treatment goals in older adults. The objective was to examine changes in blood pressure (BP) control (<140/90 mm Hg) from 2011-2013 to 2016-2017 among Black and white older adults with treated hypertension.
Participants were 1,600 white and 650 Black adults aged 71-90 years in the Atherosclerosis Risk in Communities (ARIC) Study with treated hypertension in 2011-2013 (baseline) who had BP measured in 2016-2017 (follow-up). Predictors of changes in BP control were examined by race.
BP was controlled among 75.3% of white and 65.7% of Black participants at baseline and 59.0% of white and 56.5% of Black participants at follow-up. Among those with baseline BP control, risk factors for incident uncontrolled BP included age (relative risk [RR] 1.15 per 5 years, 95% confidence interval [CI] 1.07-1.25), female sex (RR 1.36, 95% CI 1.16-1.60), and chronic kidney disease (RR 1.19, 95% CI 1.01-1.40) among white participants, and hypertension duration (RR 1.14 per 5 years, 95% CI 1.03-1.27) and diabetes (RR 1.48, 95% CI 1.15-1.91) among Black participants. Among those with uncontrolled BP at baseline, white females vs. males (RR 0.60, 95% CI 0.46-0.78) and Black participants with chronic kidney disease vs. without (RR 0.58, 95% CI 0.36-0.93) were less likely to have incident controlled BP.
BP control decreased among white and Black older adults. Black individuals with diabetes or chronic kidney disease were less likely to have controlled BP at follow-up. Higher treatment goals may have contributed to these findings and unintended differences by race.
2014 年高血压指南提高了老年患者的治疗目标。本研究旨在观察从 2011-2013 年至 2016-2017 年期间，接受治疗的高血压黑人和白人老年患者的血压（BP）控制（<140/90mmHg）的变化情况。
该研究纳入了动脉粥样硬化风险社区（ARIC）研究中的 1600 名白人患者和 650 名黑人患者，年龄 71-90 岁，在 2011-2013 年（基线）时患有高血压并接受治疗，在 2016-2017 年（随访）时测量了血压。按种族分析了血压控制变化的预测因素。
在基线时，75.3%的白人患者和 65.7%的黑人患者血压得到控制，而在随访时，59.0%的白人患者和 56.5%的黑人患者血压得到控制。在基线时血压得到控制的患者中，新发未控制血压的危险因素包括年龄（每增加 5 年风险比[RR]为 1.15，95%置信区间[CI]为 1.07-1.25）、女性（RR 1.36，95%CI 1.16-1.60）和慢性肾脏病（RR 1.19，95%CI 1.01-1.40），而在黑人患者中，高血压病程（RR 1.14 每 5 年，95%CI 1.03-1.27）和糖尿病（RR 1.48，95%CI 1.15-1.91）也是新发未控制血压的危险因素。在基线时血压未得到控制的患者中，白人女性与男性（RR 0.60，95%CI 0.46-0.78）和黑人患者中患有慢性肾脏病与未患有慢性肾脏病（RR 0.58，95%CI 0.36-0.93）相比，新发血压控制的可能性更低。
白人和黑人老年患者的血压控制情况有所下降。患有糖尿病或慢性肾脏病的黑人患者在随访时血压控制的可能性更低。更高的治疗目标可能是造成这些发现以及按种族出现意外差异的原因。
