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美国成人高血压患者血压控制趋势分析
作者:小柯机器人 发布时间:2020/9/12 22:28:16

美国阿拉巴马大学伯明翰分校Paul Muntner团队分析了1999-2000年至2017-2018年间美国成人高血压患者血压控制的趋势。2020年9月9日,《美国医学会杂志》发表了该成果。

控制血压(BP)可以降低患心血管疾病的风险。

为了确定从1999-2000年至2017-2018年美国成人高血压患者的血压控制情况是否发生变化,研究组采用全国健康和营养检查的数据,对18262名18岁以上的高血压成人在1999-2000至2017-2018年间(10个周期)进行分析,高血压定义为收缩压高于140 mmHg,舒张压高于90 mmHg,或使用抗高血压药物治疗。血压控制定义为收缩压低于140 mmHg,舒张压低于90 mmHg。

51761名成人参与者的平均年龄为48岁,50.1%为女性,43.2%为非西班牙裔白人,21.6%为非西班牙裔黑人,5.3%为非西班牙裔亚洲人,26.1%为西班牙裔。经年龄校正后,18262名成年人的血压控制率从1999-2000年的31.8%增加至2007-2008年的48.5%(差异显著),保持平稳并在2013-2014年增至53.8%,但在2017-2018年又降至43.7%(差异显著)。

45-64岁的成年人血压控制率为49.7%,显著高于18-44岁的成年人(36.7%);而75岁以上老年人血压控制率为37.3%,与18-44岁成年人相差不大。非西班牙裔白人的血压控制率为48.2%,显著高于非西班牙裔黑人(41.5%)。拥有私人保险、医疗保险、医保或医补以外国家健康保险的参与者血压控制率分别为48.2%、53.4%和43.2%,均显著高于没有医疗保险的参与者(24.2%)。社区有常规医疗机构的参与者血压控制率为48.4%,显著高于没有常规医疗机构者(26.5%)。过去一年中有过卫生保健服务的人群血压控制率为49.1%,显著高于没有卫生保健服务者(8.0%)。

总之,在对美国成年人进行的这项横断面调查中,从1999-2000年至2007-2008年间,人群血压控制率上升,2007-2008年至2013-2014年没有显著变化,但在2013-2014年之后有所下降。

附:英文原文

Title: Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018

Author: Paul Muntner, Shakia T. Hardy, Lawrence J. Fine, Byron C. Jaeger, Gregory Wozniak, Emily B. Levitan, Lisandro D. Colantonio

Issue&Volume: 2020-09-09

Abstract:

Importance  Controlling blood pressure (BP) reduces the risk for cardiovascular disease.

Objective  To determine whether BP control among US adults with hypertension changed from 1999-2000 through 2017-2018.

Design, Setting, and Participants  Serial cross-sectional analysis of National Health and Nutrition Examination Survey data, weighted to be representative of US adults, between 1999-2000 and 2017-2018 (10 cycles), including 18262 US adults aged 18 years or older with hypertension defined as systolic BP level of 140 mm Hg or higher, diastolic BP level of 90 mm Hg or higher, or use of antihypertensive medication. The date of final data collection was 2018.

Exposures  Calendar year.

Main Outcomes and Measures  Mean BP was computed using 3 measurements. The primary outcome of BP control was defined as systolic BP level lower than 140 mm Hg and diastolic BP level lower than 90 mm Hg.

Results  Among the 51761 participants included in this analysis, the mean (SD) age was 48 (19) years and 25939 (50.1%) were women; 43.2% were non-Hispanic White adults; 21.6%, non-Hispanic Black adults; 5.3%, non-Hispanic Asian adults; and 26.1%, Hispanic adults. Among the 18262 adults with hypertension, the age-adjusted estimated proportion with controlled BP increased from 31.8% (95% CI, 26.9%-36.7%) in 1999-2000 to 48.5% (95% CI, 45.5%-51.5%) in 2007-2008 (P<.001 for trend), remained stable and was 53.8% (95% CI, 48.7%-59.0%) in 2013-2014 (P=.14 for trend), and then declined to 43.7% (95% CI, 40.2%-47.2%) in 2017-2018 (P=.003 for trend). Compared with adults who were aged 18 years to 44 years, it was estimated that controlled BP was more likely among those aged 45 years to 64 years (49.7% vs 36.7%; multivariable-adjusted prevalence ratio, 1.18 [95% CI, 1.02-1.37]) and less likely among those aged 75 years or older (37.3% vs 36.7%; multivariable-adjusted prevalence ratio, 0.81 [95% CI, 0.65-0.97]). It was estimated that controlled BP was less likely among non-Hispanic Black adults vs non-Hispanic White adults (41.5% vs 48.2%, respectively; multivariable-adjusted prevalence ratio, 0.88; 95% CI, 0.81-0.96). Controlled BP was more likely among those with private insurance (48.2%), Medicare (53.4%), or government health insurance other than Medicare or Medicaid (43.2%) vs among those without health insurance (24.2%) (multivariable-adjusted prevalence ratio, 1.40 [95% CI, 1.08-1.80], 1.47 [95% CI, 1.15-1.89], and 1.36 [95% CI, 1.04-1.76], respectively). Controlled BP was more likely among those with vs those without a usual health care facility (48.4% vs 26.5%, respectively; multivariable-adjusted prevalence ratio, 1.48 [95% CI, 1.13-1.94]) and among those who had vs those who had not had a health care visit in the past year (49.1% vs 8.0%; multivariable-adjusted prevalence ratio, 5.23 [95% CI, 2.88-9.49]).

Conclusions and Relevance  In a series of cross-sectional surveys weighted to be representative of the adult US population, the prevalence of controlled BP increased between 1999-2000 and 2007-2008, did not significantly change from 2007-2008 through 2013-2014, and then decreased after 2013-2014.

DOI: 10.1001/jama.2020.14545

Source: https://jamanetwork.com/journals/jama/fullarticle/2770254

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
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex