美国 1 期高血压成年人中 PREVENT 方程预测的心血管风险。

Predicted Cardiovascular Risk by the PREVENT Equations in US Adults With Stage 1 Hypertension.

机构信息

Department of Epidemiology, University of Alabama at Birmingham (P.M., K.F., L.G., L.C.).

Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC (B.C.J.).

出版信息

Hypertension. 2024 Sep;81(9):1976-1985. doi: 10.1161/HYPERTENSIONAHA.124.22998. Epub 2024 Jul 15.

DOI:10.1161/HYPERTENSIONAHA.124.22998

PMID:39005226

Abstract

BACKGROUND

The 2017 American College of Cardiology/American Heart Association blood pressure guideline recommends initiation of antihypertensive medication for adults with stage 1 hypertension (systolic blood pressure, 130-139 mm Hg, or diastolic blood pressure, 80-89 mm Hg) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥10% estimated by the pooled cohort equations (PCEs). In 2023, the American Heart Association published the predicting risk of cardiovascular disease events (PREVENT) equations to estimate ASCVD and total cardiovascular disease risk.

METHODS

We analyzed US National Health and Nutrition Examination Survey data from 2013 to 2020 for 1703 adults aged 30 to 79 years without self-reported cardiovascular disease with stage 1 hypertension. We estimated 10-year ASCVD risk by the PCEs and 10-year ASCVD and total cardiovascular disease risk by the base PREVENT equations. Analyses were weighted to represent noninstitutionalized US adults with stage 1 hypertension.

RESULTS

Mean 10-year ASCVD risk was 5.4% (95% CI, 5.0%-5.9%) and 2.9% (95% CI, 2.7%-3.1%) using the PCEs and PREVENT equations, respectively. The proportion with 10-year ASCVD risk of 10% to <15% and ≥15% was 8.1% and 7.8% estimated by the PCEs, respectively, and 3.0% and 0.3% estimated by the PREVENT equations, respectively. No participants had a 10-year ASCVD risk ≥10% on the PREVENT equations and <10% on the PCEs, while 12.5% had a 10-year ASCVD risk ≥10% on the PCEs and <10% on the PREVENT equations. The mean 10-year total cardiovascular disease risk estimated by the PREVENT equations was lower than the mean 10-year ASCVD risk on the PCEs.

CONCLUSIONS

Among US adults with stage 1 hypertension, the 10-year predicted ASCVD risk estimated by the PREVENT equations was approximately half the risk estimated by the PCEs.

摘要

背景

2017 年美国心脏病学会/美国心脏协会血压指南建议，对于收缩压 130-139mmHg 或舒张压 80-89mmHg 的 1 期高血压患者和通过汇总队列方程（PCE）估计的 10 年动脉粥样硬化性心血管疾病（ASCVD）风险≥10%的患者开始使用降压药物。2023 年，美国心脏协会发布了预测心血管疾病事件风险（PREVENT）方程，以估计 ASCVD 和总心血管疾病风险。

方法

我们分析了 2013 年至 2020 年美国国家健康与营养调查（NHANES）中 1703 名年龄在 30 至 79 岁之间无心血管疾病自我报告且患有 1 期高血压的成年人数据。我们使用 PCE 估计 10 年 ASCVD 风险，使用基础 PREVENT 方程估计 10 年 ASCVD 和总心血管疾病风险。分析结果经过加权处理，以代表患有 1 期高血压的非住院美国成年人。

结果

使用 PCE 和 PREVENT 方程分别估计平均 10 年 ASCVD 风险为 5.4%（95%CI，5.0%-5.9%）和 2.9%（95%CI，2.7%-3.1%）。使用 PCE 分别估计 10 年 ASCVD 风险为 10%-<15%和≥15%的比例分别为 8.1%和 7.8%，使用 PREVENT 方程分别估计为 3.0%和 0.3%。没有参与者在 PREVENT 方程上的 10 年 ASCVD 风险≥10%，而在 PCE 上的 10 年 ASCVD 风险<10%，而在 PCE 上的 12.5%的 10 年 ASCVD 风险≥10%，而在 PREVENT 方程上的 10 年 ASCVD 风险<10%。使用 PREVENT 方程估计的平均 10 年总心血管疾病风险低于使用 PCE 估计的平均 10 年 ASCVD 风险。