ACC/AHA血压指南定义的单纯舒张性高血压与心血管事件结局无关 作者： 发布时间：/2/7 9:39:37 美国约翰霍普金斯大学彭博公共卫生学院Elizabeth Selvin联合爱尔兰国立高威大学医学院John W. McEvoy课题组近期取得重大进展，他们探讨了ACC/AHA血压指南定义的单纯舒张期高血压与心血管事件结局的关系。相关论文发表在1月28日出版的《美国医学会杂志》上。
美国心脏病学会（ACC）/美国心脏协会（AHA）指南中，高血压的定义从高于140/90mmHg降为高于130/80mmHg。根据专家意见，推荐单纯舒张性高血压（IDH）的阈值为80mmHg。
研究组进行了一项国家健康和营养检查调查（NHANES）的横断面分析和社区动脉粥样硬化风险的纵向分析。IDH由ACC/AHA（收缩压低于130mmHg，舒张压高于80mmHg）和联合国家委员会（JNC7，收缩压低于140mmHg，舒张压超过90mmHg）来定义。
NHANES研究共纳入9590名参与者，平均年龄49.6岁，女性占52.3%；ARIC研究共纳入8703名参与者，平均基线年龄为56.0岁，女性占57.2%。根据ACC/AHA建议，NHANES中IDH的估计患病率为6.5%，根据JNC7定义则为1.3%。
在新纳入IDH的患者中，预计0.6%达到了抗高血压治疗的指导阈值。与血压正常的ARIC参与者相比，根据ACC/AHA定义的IDH与动脉粥样硬化性心血管疾病（ASCVD）、心力衰竭（HF）和慢性肾病（CKD）的发生率并无显著相关性。两个外部队列均无心血管死亡发生。
总之，在这项针对美国成年人的分析中，ACC/AHA BP指南与JNC7指南相比，IDH的预计患病率更为常见。但IDH与心血管疾病风险的增加不相关。
附：英文原文
Title: Association of Isolated Diastolic Hypertension as Defined by the ACC/AHA Blood Pressure Guideline With Incident Cardiovascular Outcomes
Author: John W. McEvoy, Natalie Daya, Faisal Rahman, Ron C. Hoogeveen, Roger S. Blumenthal, Amil M. Shah, Christie M. Ballantyne, Josef Coresh, Elizabeth Selvin
Issue Volume: /01/28
Abstract:
Importance In the American College of Cardiology (ACC)/American Heart Association (AHA) guideline, the definition of hypertension was lowered from a blood pressure (BP) of greater than or equal to 140/90 to greater than or equal to 130/80 mm Hg. The new diastolic BP threshold of 80 mm Hg was recommended based on expert opinion and changes the definition of isolated diastolic hypertension (IDH).
Objective To compare the prevalence of IDH in the United States, by ACC/AHA and Joint National Committee (JNC7) definitions, and to characterize cross-sectional and longitudinal associations of IDH with outcomes.
Design, Setting, and Participants Cross-sectional analyses of the National Health and Nutrition Examination Survey (NHANES -) and longitudinal analyses of the Atherosclerosis Risk in Communities (ARIC) Study (baseline 1990-1992, with follow-up through December 31, ). Longitudinal results were validated in 2 external cohorts: (1) the NHANES III (1988-1994) and NHANES 1999- and (2) the Give Us a Clue to Cancer and Heart Disease (CLUE) II cohort (baseline 1989).
Exposures IDH, by ACC/AHA (systolic BP 130 mm Hg, diastolic BP 80 mm Hg) and by JNC7 (systolic BP 140 mm Hg, diastolic BP 90 mm Hg) definitions.
Main Outcomes and Measures Weighted estimates for prevalence of IDH in US adults and prevalence of US adults recommended BP pharmacotherapy by the ACC/AHA guideline based solely on the presence of IDH. Risk of incident atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD) in the ARIC Study.
Results The study population included 9590 adults from the NHANES (mean [SD] baseline age, 49.6 [17.6] years; 5016 women [52.3%]) and 8703 adults from the ARIC Study (mean [SD] baseline age, 56.0 [5.6] years; 4977 women [57.2%]). The estimated prevalence of IDH in the NHANES was 6.5% by the ACC/AHA definition and 1.3% by the JNC7 definition (absolute difference, 5.2% [95% CI, 4.7%-5.7%]). Among those newly classified as having IDH, an estimated 0.6% (95% CI, 0.5%-0.6%) also met the guideline threshold for antihypertensive therapy. Compared with normotensive ARIC participants, IDH by the ACC/AHA definition was not significantly associated with incident ASCVD (n?=?1386 events; median follow-up, 25.2 years; hazard ratio [HR], 1.06 [95% CI, 0.89-1.26]), HF (n?=?1396 events; HR, 0.91 [95% CI, 0.76-1.09]), or CKD (n?=?2433 events; HR, 0.98 [95% CI, 0.65-1.11]). Results were also null for cardiovascular mortality in the 2 external cohorts (eg, HRs of IDH by the ACC/AHA definition were 1.17 [95% CI, 0.87-1.56] in the NHANES [n?=?1012 events] and 1.02 [95% CI, 0.92-1.14] in CLUE II [n?=?1497 events]).
Conclusions and Relevance In this analysis of US adults, the estimated prevalence of IDH was more common when defined by the ACC/AHA BP guideline compared with the JNC7 guideline. However, IDH was not significantly associated with increased risk for cardiovascular outcomes.
DOI: 10.1001/jama..21402
Source:
期刊信息
JAMA-Journal of The American Medical Association：《美国医学会杂志》，创刊于1883年。隶属于美国医学协会，最新IF：51.273
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