Department of Population-Based Medicine, University of Tübingen, Tübingen, Germany.
PLoS One. 2023 Aug 21;18(8):e0290344. doi: 10.1371/journal.pone.0290344. eCollection 2023.
The early initiation of antihypertensive drug therapy is conceived as one of the most important public health interventions addressing cardiovascular risk in the population. However, the actual contribution of this public health intervention to reduce blood pressure (BP) at the population level is largely unknown. Hence, the aim of the present investigation is to estimate the potential public health effects of the use of antihypertensive medication on BP in the population aged 16 and older. Data from three population health surveys periodically conducted in the United States, England, and Scotland are analysed (N = 362,275). The secular trends of BP measurements and the potential public health impact of the use of antihypertensive medications on BP over time are analysed in a series of linear mixed models. Between 1992 and 2019, a secular trend of decreasing systolic and diastolic BP occurred (-16.24 99% CI [-16.80; -15.68] and -3.08 99% CI [-3.36; -2.80] mmHg, respectively). The potential public health impact of the use of antihypertensive medications in the period 1992-2019 on systolic BP was estimated to lie between -8.56 99% CI [-8.34; -8.77] and -8.68 99% CI [-8.33; -9.03] mmHg. Average reduction of diastolic BP was in the range of -5.56 99% CI [-5.71; -5.42] and -6.55 99% CI [-6.78; -6.32] mmHg. The observed changes in the distribution of BP measurements over time were found to be more strongly related to secular trends affecting the whole populations, rather than to increases in the proportion of individuals taking antihypertensive medications.
降压药物治疗的早期启动被认为是针对人群心血管风险的最重要的公共卫生干预措施之一。然而，这种公共卫生干预措施对降低人群血压（BP）的实际贡献在很大程度上尚不清楚。因此，本研究旨在估计降压药物在 16 岁及以上人群中对 BP 的潜在公共卫生影响。对在美国、英国和苏格兰定期进行的三项人群健康调查的数据进行了分析（N=362275）。在一系列线性混合模型中，分析了 BP 测量的长期趋势以及降压药物随时间推移对 BP 的潜在公共卫生影响。在 1992 年至 2019 年期间，收缩压和舒张压呈下降趋势（分别为-16.24[99%CI：-16.80；-15.68]和-3.08[99%CI：-3.36；-2.80]mmHg）。在 1992 年至 2019 年期间，降压药物使用对收缩压的潜在公共卫生影响估计为-8.56[99%CI：-8.34；-8.77]和-8.68[99%CI：-8.33；-9.03]mmHg。舒张压的平均降幅在-5.56[99%CI：-5.71；-5.42]和-6.55[99%CI：-6.78；-6.32]mmHg 之间。随着时间的推移，BP 测量分布的变化与影响整个人群的长期趋势更为密切相关，而不是与服用降压药物的人数比例的增加有关。
