背景:我们比较了患病率,意识,治疗,并根据两项高血压指南控制了伊朗的高血压;2017年ACC/AHA-积极的血压目标为130/80mmHg-,常用的JNC8指南截止值为140/90mmHg。我们揭示了2017年ACC/AHA对符合非药物和药物治疗资格的人群亚组和高危人群的影响。
方法:数据来自伊朗国家STEPS2016研究。参与者包括27,738名年龄≥25岁的成年人作为伊朗人的代表性样本。调查设计的回归模型用于检查患病率的决定因素,意识,治疗,控制高血压.
结果:基于JNC8的高血压患病率为29.9%(95%CI:29.2-30.6),根据2017年ACC/AHA的数据,这一比例飙升至53.7%(52.9-54.4)。意识的百分比,治疗,对照组为59.2%(58.0-60.3),80.2%(78.9-81.4),和39.1%(37.4-40.7),基于JNC8,下降到37.1%(36.2-38.0),71.3%(69.9-72.7),和19.6%(18.3-21.0),分别,通过应用2017ACC/AHA。根据新的指导方针,25~34岁的成年人的患病率增加幅度最大(从7.3%增加到30.7%).他们的知晓率和治疗率也最低,与年龄组之间的最高控制率(36.5%)相反。与JNC8相比,基于2017年ACC/AHA,24、15、17和11%以上的血脂异常患者,高甘油三酯,糖尿病,和心血管疾病事件,分别,属于高血压类别。然而,基于2017年ACC/AHA,68.2%的高血压患者有资格接受药物治疗(JNC8中为95.7%)。LDL胆固醇<130mg/dL,足够的体力活动(代谢当量≥600/周),和身体质量指数被发现改变血压-3.56(-4.38,-2.74),-2.04(-2.58,-1.50),和0.48(0.42,0.53)mmHg,分别。
结论:从JNC8切换到2017年ACC/AHA的患病率急剧增加,意识急剧下降,治疗,并控制在伊朗。根据2017年ACC/AHA,更多的年轻人和患有慢性合并症的人属于高血压类别;这些人可能受益于早期干预措施,例如改变生活方式.接受治疗的个人控制率较低,因此需要对高血压服务进行严格审查。
BACKGROUND: We compared the prevalence, awareness, treatment, and control of hypertension in Iran based on two hypertension
guidelines; the 2017 ACC/AHA -with an aggressive blood pressure target of 130/80 mmHg- and the commonly used JNC8
guideline cut-off of 140/90 mmHg. We shed light on the implications of the 2017 ACC/AHA for population subgroups and high-risk individuals who were eligible for non-pharmacologic and pharmacologic therapies.
METHODS: Data was obtained from the Iran national STEPS 2016 study. Participants included 27,738 adults aged ≥25 years as a representative sample of Iranians. Regression models of survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension.
RESULTS: The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) based on the 2017 ACC/AHA. The percentage of awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0), respectively, by applying the 2017 ACC/AHA. Based on the new
guideline, adults aged 25-34 years had the largest increase in prevalence (from 7.3 to 30.7%). They also had the lowest awareness and treatment rate, contrary to the highest control rate (36.5%) between age groups. Compared with JNC8, based on the 2017 ACC/AHA, 24, 15, 17, and 11% more individuals with dyslipidaemia, high triglycerides, diabetes, and cardiovascular disease events, respectively, fell into the hypertensive category. Yet, based on the 2017 ACC/AHA, 68.2% of individuals falling into the hypertensive category were eligible for receiving pharmacologic therapy (versus 95.7% in JNC8). LDL cholesterol< 130 mg/dL, sufficient physical activity (Metabolic Equivalents≥600/week), and Body Mass Index were found to change blood pressure by - 3.56(- 4.38, - 2.74), - 2.04(- 2.58, - 1.50), and 0.48(0.42, 0.53) mmHg, respectively.
CONCLUSIONS: Switching from JNC8 to 2017 ACC/AHA sharply increased the prevalence and drastically decreased the awareness, treatment, and control in Iran. Based on the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category; these individuals might benefit from earlier interventions such as lifestyle modifications. The low control rate among individuals receiving treatment warrants a critical review of hypertension services.