2017年ACC/AHA高血压指南对贵阳城区40~79岁不同糖代谢状态人群高血压患病情况的可能影响

Potential effects of 2017 ACC/AHA hypertension guideline on the prevalence of hypertension among population aged 40-79 with different glucose metabolism in Guiyang city

目的探讨2017年美国心脏病学会/美国心脏协会(ACC/AHA)指南提出的新的高血压诊断标准下贵阳城区40~79岁不同糖代谢状态人群的高血压患病情况,为高血压的诊断标准及高血压的治疗策略提供线索。方法回顾性分析了中国2型糖尿病患者肿瘤发生风险的流行病学(REACTION)研究贵阳分中心的10140名40~79岁居民,根据糖尿病病史及口服葡萄糖耐量试验结果分为血糖正常组、空腹血糖受损(IFG)组、糖耐量受损(IGT)组、IFG+IGT组、既往诊断糖尿病组及新诊断糖尿病组,计算在美国预防、检测、评估与治疗高血压全国联合委员会第七次报告(JNC 7)及2017年ACC/AHA的高血压指南标准下不同糖代谢状态人群的高血压患病情况。结果在JNC 7标准下,贵阳城区40~79岁血糖正常人群、糖尿病前期人群、糖尿病人群的高血压标准化患病率分别为8.19%、9.57%、8.19%。在2017年ACC/AHA标准下,高血压的标准化患病率分别为20.27%、16.35%、11.59%。相比之下,以血糖正常及IGT人群的高血压患病率增加最为显著。新增的高血压患者共1739例,其中25.8%需应用降压药物治疗。根据2010年第六次人口普查贵州省人口数据,估计贵阳市40~79岁糖尿病前期人群中新增的高血压患者约12.3万人,新增需治疗人数约2.0万人;糖尿病人群中新增高血压患者约6.8万人,新增需治疗人数约2.1万余人。结论2017年ACC/AHA高血压指南会使贵阳市城区40~79岁不同糖代谢状态人群的高血压患病率明显增加,糖尿病及糖尿病前期的高血压人群的需治疗比例也会相当高,社会医疗负担加重。

Objective To discuss hypertension situations of 40-79 years old residents with different glucose metabolic status in Guiyang urban area under the new hypertension diagnostic criteria proposed by American College of Cardiology/American Heart Association(ACC/AHA)in 2017 and provide a clue for diagnostic criteria and treatment strategy of hypertension.Methods 10140 residents in 40-79 years old in Risk Evaluation of cAncers in Chinese diabeTic Individuals:a IONgitudinal(REACTION)Study Research Guiyang Sub-center were conducted retrospective analysis.According to medical history of diabetes and oral glucose tolerance test results,these residents were divided into normal glucose group,impaired fasting glucose(IFG)group,impaired glucose tolerance(IGT)group,IFG+IGF group,previous diagnostic diabetes group and newly diagnosed diabetes group.Hypertension situation of residents with different glucose metabolic status under the Seventh Report of the Joint National Committee on Prevention,Detection,Evaluation,and Treatment of High Blood Pressure(JNC 7),and Hypertension Guide of ACC/AHA in 2017 were calculated.Results Under JNC 7 criteria,hypertension′s standardized prevalence rate of normal blood glucose people,prediabetes patients,and diabetes patients in 40-79 years old respectively reached 8.19%,9.57%,and 8.19%.Under ACC/AHA 2017 criteria,hypertension′s standardized prevalence rate respectively reached 20.27%,16.35%,and 11.59%.By contrast,the most obvious increase of hypertension′s prevalence rate was in the normal blood glucose group and IGT group.Newly increased hypertension patients reached 1739.Among them,25.8%required antihypertensive drugs for treatment.According to the 6th demographic census data of Guizhou Province in 2010,it was estimated that newly increased hypertensive patients aged 40-79 years in prediabetes patients reached 123000,among them,20000 required treatment.Newly increased hypertensive patients aged 40-79 years in diabetes patients reached 68000,among them,21000 required treatment.Conclusions ACC/AHA Hypertension Guide in 2017 will obviously increase hypertension′s prevalence rate of people with different glucose metabolic status in 40-49 years old.The treatment ratio of hypertension groups with diabetes and prediabetes is considerably high.As a result,social medical burdens is going to aggravate.