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1.
JAMA ; 323(4): 329-338, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31990314

RESUMO

Importance: In the 2017 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 2017 ACC/AHA and 2003 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 2013-2016) and longitudinal analyses of the Atherosclerosis Risk in Communities (ARIC) Study (baseline 1990-1992, with follow-up through December 31, 2017). Longitudinal results were validated in 2 external cohorts: (1) the NHANES III (1988-1994) and NHANES 1999-2014 and (2) the Give Us a Clue to Cancer and Heart Disease (CLUE) II cohort (baseline 1989). Exposures: IDH, by 2017 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 2017 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 2017 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 2017 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 2017 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 2017 ACC/AHA BP guideline compared with the JNC7 guideline. However, IDH was not significantly associated with increased risk for cardiovascular outcomes.


Assuntos
Doenças Cardiovasculares/etiologia , Hipertensão/epidemiologia , Guias de Prática Clínica como Assunto , Adulto , Idoso , American Heart Association , Biomarcadores/sangue , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Diástole , Feminino , Humanos , Hipertensão/sangue , Hipertensão/complicações , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , Fatores de Risco , Sociedades Médicas , Estados Unidos/epidemiologia , Adulto Jovem
2.
Rev Med Chil ; 147(5): 545-556, 2019 May.
Artigo em Espanhol | MEDLINE | ID: mdl-31859886

RESUMO

INTRODUCTION AND OBJECTIVE: There is little evidence in Latin America about the impact of the ACC/AHA 2017 guideline. Taking as reference the JNC 7 guideline, the objective of our study is to estimate changes in the prevalence of arterial hypertension (HBP) according to socio-demographic characteristics and geographic regions, applying the criteria of the new ACC / AHA guide 2017. METHODS: Cross-sectional study of the Demographic and Family Health Survey conducted in Peru in 2017. Standardized weighted hypertension prevalence's were estimated for the WHO population according to both guidelines, and absolute differences with 95% CI. RESULTS: We included 30,682 people aged 18 years and over, with an average age of 42.3 years, 51.1% women. The standardized prevalence of HBP for 2017 according to JNC 7 was 14.4% (95% CI: 13.8-15.1) and according to ACC / AHA 2017 it was 32.9% (95% CI: 32.0-33.7), so the prevalence increase is 18.5 percentage points, being higher in males than females (24.2 vs 12.9 respectively). In people with obesity and / or who consume tobacco, the increases were higher (24.3 and 24.1 percentage points respectively). In the regions of Tacna, Ica and Metropolitan Lima, the increase, in comparison with the JNC 7 guidelines, overcome the national average (22.4, 20.7 and 20.4, percentage points, respectively). CONCLUSIONS: Considering the context of a Latin American country and knowing the epidemiology of hypertension in Peru, the potential adoption of the ACC/AHA 2017 guidelines for the prevention, detection, evaluation, and management of hypertension should be accompanied by an evaluation of the impact at the individual, system and social level.


Assuntos
Guias como Assunto , Hipertensão/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , American Heart Association , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Prevalência , Padrões de Referência , Distribuição por Sexo , Fumar/epidemiologia , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
5.
Stud Health Technol Inform ; 264: 1017-1020, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438078

RESUMO

Recently the two most influential clinical guideline were published for diagnosing and treating hypertension in US and Europe: 2017 American College of Cardiology/American Heart Association (ACC/AHA) and 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guideline. Though both of them have most in common, the differences in details between guidelines have confused many clinicians in the world. Because guidelines were evidence- based literature, through the analysis of articles cited in guidelines, these similarities and differences could be explained. Bibliometric analysis is a method of quantifying the contents of literature to analyze literature. So using the bibliometric analysis including co-citation network analysis, articles cited in guideline were analyzed. As a result, we figured out that bibliometrics can analyze the influence of the countries, authors and studies on the guidelines, which might affect on the similarities and the differences between both guidelines.


Assuntos
Hipertensão , American Heart Association , Bibliometria , Cardiologia , Europa (Continente) , Humanos , Estados Unidos
6.
Hypertension ; 74(4): 776-783, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31378104

RESUMO

The new American College of Cardiology/American Heart Association guideline reclassified office blood pressure and proposed thresholds for ambulatory blood pressure (ABP). We derived outcome-driven ABP thresholds corresponding with the new office blood pressure categories. We performed 24-hour ABP monitoring in 11 152 participants (48.9% women; mean age, 53.0 years) representative of 13 populations. We determined ABP thresholds resulting in multivariable-adjusted 10-year risks similar to those associated with elevated office blood pressure (120/80 mm Hg) and stages 1 and 2 of office hypertension (130/80 and 140/90 mm Hg). Over 13.9 years (median), 2728 (rate per 1000 person-years, 17.9) people died, 1033 (6.8) from cardiovascular disease; furthermore, 1988 (13.8), 893 (6.0), and 795 (5.4) cardiovascular and coronary events and strokes occurred. Using a composite cardiovascular end point, systolic/diastolic outcome-driven thresholds indicating elevated 24-hour, daytime, and nighttime ABP were 117.9/75.2, 121.4/79.6, and 105.3/66.2 mm Hg. For stages 1 and 2 ambulatory hypertension, thresholds were 123.3/75.2 and 128.7/80.7 mm Hg for 24-hour ABP, 128.5/79.6 and 135.6/87.1 mm Hg for daytime ABP, and 111.7/66.2 and 118.1/72.5 mm Hg for nighttime ABP. ABP thresholds derived from other end points were similar. After rounding, approximate thresholds for elevated 24-hour, daytime, and nighttime ABP were 120/75, 120/80, and 105/65 mm Hg, and for stages 1 and 2, ambulatory hypertension 125/75 and 130/80 mm Hg, 130/80 and 135/85 mm Hg, and 110/65 and 120/70 mm Hg. Outcome-driven ABP thresholds corresponding to elevated blood pressure and stages 1 and 2 of hypertension are similar to those proposed by the current American College of Cardiology/American Heart Association guideline.


Assuntos
Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/fisiopatologia , Hipertensão/diagnóstico , Adulto , Idoso , American Heart Association , Monitorização Ambulatorial da Pressão Arterial/métodos , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos
9.
Sleep Health ; 5(5): 501-508, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31302068

RESUMO

BACKGROUND AND OBJECTIVE: Sleep is an emerging risk factor for cardiovascular disease (CVD) that is not currently included as a cardiovascular health (CVH) metric in the American Heart Association's Life's Simple 7 (AHA LS7). Our objective was to evaluate the association of sleep with CVH in women and examine differences by menopausal status and race/ethnicity. METHODS: Baseline data from the Columbia University AHA Go Red for Women Strategically Focused Research Network were examined. Sleep habits were self-reported using validated questionnaires. A CVH score was computed using AHA LS7 criteria for smoking, diet, physical activity, BMI, blood pressure(BP), total cholesterol, and fasting glucose. Women received a score of 2 (ideal), 1 (intermediate), or 0 (poor) based on their level of meeting each AHA LS7 metric. Multivariable-adjusted regression models were used to evaluate associations of sleep with meeting overall and individual CVH metrics. RESULTS: The analytical sample consisted of n = 507 women (62% minority/Hispanic, mean age:37 y). Participants with adequate sleep duration (≥7 h), good sleep quality, no insomnia nor snoring, and low risk for OSA were more likely to meet >4 of the AHA LS7 metrics (P < .01). Poorer sleep quality (ß = -0.08, P = .002), higher insomnia severity (ß = -0.05, P = .002), snoring (ß = -0.77, P = .0001), and higher risk for OSA (ß = -1.63, P < .0001) were associated with poorer CVH. Insomnia, snoring, and high OSA risk were associated with 69% to >300% higher odds of having poor CVH (P ≤ .03). Associations were stronger in post-menopausal and racial/ethnic minority women. CONCLUSIONS: Better sleep habits were associated with more favorable CVH among women, suggesting that there may be benefit in incorporating sleep assessment into CVD risk screening.


Assuntos
Doenças Cardiovasculares/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Menopausa , Sono , Adulto , Idoso , American Heart Association , Doenças Cardiovasculares/etnologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
11.
High Blood Press Cardiovasc Prev ; 26(3): 247-257, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31201617

RESUMO

INTRODUCTION: Hypertension is a leading global risk factor for death and disability. Seeking new ways to prevent and treat hypertension is a priority for scientists and healthcare professionals worldwide. In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) issued a new hypertension guideline shifting the definition of hypertension from 140/90 mm Hg to 130/80 mm Hg for systolic/diastolic blood pressure. This new diagnostic threshold of hypertension has sparked a lively discussion worldwide over whether it should be applied in clinical settings to diagnose and treat hypertension. China, the world's most populous country, is facing a hypertension crisis. According to the 140/90 mm Hg guideline, China has an estimated 244.5 million population aged ≥ 18 years with hypertension, and another 435.3 million with pre-hypertension. If the new guideline is adopted, the prevalence of hypertension in China would double. This change would significantly impact patients, healthcare professionals, scientists, and policy makers in terms of the delivery of care and needed resources. AIM: This study aims to investigate whether Chinese physicians will use the 130/80 mm Hg threshold to diagnose hypertension in clinical practice. METHODS: In March 2018, we launched a mobile app-based survey to study 253 Chinese physicians' perspectives on the ACC/AHA Guideline. RESULTS: A total of 253 physicians from 21 Chinese provinces completed the survey. Nearly 80% of the participants had already noticed the ACC/AHA guideline change. The proportion of participants who said they would use the new threshold to diagnoses hypertension was 41%, while 59% said they would not use the new threshold. The primary reason for those who said "yes" was that they believed early diagnosis of hypertension can trigger early actions to prevent the increasing blood pressure. For those who said "no", they argued that their decision was based on the fact that the Chinese Hypertension Prevention Guideline had not yet changed the diagnostic threshold from 140/90 to 130/80 mm Hg. CONCLUSIONS: Different understanding of hypertension prevention and treatment exists among Chinese physicians. It is an emergent need to form an evidence-based authoritative answer to guide Chinese physicians' future clinical practice.


Assuntos
Anti-Hipertensivos/uso terapêutico , Atitude do Pessoal de Saúde , Pressão Sanguínea/efeitos dos fármacos , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão/tratamento farmacológico , Médicos/psicologia , Guias de Prática Clínica como Assunto , Adulto , American Heart Association , China/epidemiologia , Assistência à Saúde , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Padrões de Prática Médica , Prevalência , Inquéritos e Questionários , Estados Unidos
14.
Drugs Today (Barc) ; 55(4): 277-285, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31050695

RESUMO

Hypertension is a major risk factor for cardiovascular disease, heart failure, chronic kidney disease and stroke. Therefore, its early detection and treatment are very important according to blood pressure (BP) treatment guidelines issued by the various scientific societies. Over the years, BP treatment guidelines have changed from strict control of BP to more relaxed control, and lately to a strict BP control influenced by the results of the SPRINT trial. The recently published BP treatment guidelines by the American College of Cardiology/American Heart Association (ACC/AHA) recommend a systolic BP (SBP) and diastolic BP reduction to less than 130 mmHg and less than 80 mmHg, respectively, for all ages, and have also changed the classification of hypertension by changing the term "prehypertension" of the JNC 7 (7th Joint National Committee) guidelines to "stage 1 hypertension". These changes could have significant social and economic consequences for the patients. In order to get a better perspective of the current status of SBP control, we conducted a MEDLINE search of the English language literature from 2014 to 2018 in connection with recent (2014-2018) BP treatment guidelines, using the terms 'hypertension', 'blood pressure control', 'intensive blood pressure control', 'blood pressure treatment guidelines', and 'benefits and risks of intensive blood pressure control', and 26 pertinent papers were retrieved. These papers together with collateral literature, which goes beyond the year 2014, will be discussed in this review.


Assuntos
Pressão Sanguínea , Hipertensão/classificação , Guias de Prática Clínica como Assunto , American Heart Association , Doenças Cardiovasculares/complicações , Humanos , Insuficiência Renal Crônica/complicações , Acidente Vascular Cerebral/complicações , Estados Unidos
15.
Ann Intern Med ; 170(9): ITC65-ITC80, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31060074

RESUMO

Recent guidelines on diagnosis and management of high blood pressure (BP) include substantial changes and several new concepts compared with previous guidelines. These are reviewed and their clinical implications are discussed in this article. The goal is to provide a practical reference to assist clinicians with up-to-date management of patients with high BP. Important issues include new diagnostic thresholds, out-of-office BP monitoring, intensified treatment goals, and a different approach to resistant hypertension. Finally, differences among guidelines, the persistent controversies that have led to them, and their implications for clinical practice are discussed.


Assuntos
Hipertensão/diagnóstico , Hipertensão/terapia , Guias de Prática Clínica como Assunto , American Heart Association , Anti-Hipertensivos/administração & dosagem , Determinação da Pressão Arterial/normas , Monitorização Ambulatorial da Pressão Arterial , Relações Comunidade-Instituição , Combinação de Medicamentos , Humanos , Estilo de Vida , Programas de Rastreamento , Anamnese , Adesão à Medicação , Equipe de Assistência ao Paciente , Potássio na Dieta/administração & dosagem , Pré-Hipertensão/diagnóstico , Sódio na Dieta/administração & dosagem , Telemedicina , Estados Unidos
16.
Hypertension ; 73(6): 1210-1216, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31067203

RESUMO

Although the American College of Cardiology/American Heart Association guidelines have introduced a novel definition of hypertension in their 2017 hypertension guidelines, the influence of novel stage 1 hypertension on cerebrovascular diseases remains unclear. In this study, we evaluated the relationship between stage 1 hypertension, as defined by the 2017 American College of Cardiology/American Heart Association guidelines and cerebral small vessel disease in a healthy population. We assessed consecutive health checkup participants without the use of antihypertensive medication between 2006 and 2013. White matter hyperintensity volumes were rated using semiautomated quantitative methods. The presence of lacunes, cerebral microbleeds, and enlarged perivascular spaces was also measured as cerebral small vessel disease lesions. We classified the blood pressure of all participants according to the 2017 American College of Cardiology/American Heart Association guidelines. A total of 2460 participants were evaluated. In adjusted linear and logistic regression analyses, stage 1 hypertension was independently associated with white matter hyperintensity volume (ß=0.158; 95% CI, 0.046-0.269; P=0.006), presence of lacune (adjusted odds ratio, 1.66; 95% CI, 1.00-2.73; P=0.048), and deep cerebral microbleeds (adjusted odds ratio, 2.50, 95% CI, 1.08-5.79; P=0.033). Stage 2 hypertension showed higher coefficients or adjusted odds ratio values and lower P values in all analyses of white matter hyperintensity volumes, lacunes, and deep cerebral microbleeds, indicating dose-response effects across blood pressure categories. Stage 1 hypertension according to the 2017 American College of Cardiology/American Heart Association guidelines is associated with cerebral small vessel disease lesions, especially in white matter hyperintensity lesions, lacunes, and deep cerebral microbleeds.


Assuntos
American Heart Association , Pressão Sanguínea/fisiologia , Cardiologia , Doenças de Pequenos Vasos Cerebrais/diagnóstico , Guias como Assunto , Hipertensão/complicações , Sociedades Médicas , Encéfalo/patologia , Doenças de Pequenos Vasos Cerebrais/etiologia , Doenças de Pequenos Vasos Cerebrais/fisiopatologia , Feminino , Seguimentos , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estados Unidos
19.
Clin Chim Acta ; 495: 82-84, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30953613

RESUMO

The American Heart Association (AHA) and American College of Cardiology (ACC) recently published new guidelines for managing blood cholesterol. Five years from the publication of Pooled Cohort Equation to estimate 10-year risk of atherosclerotic cardiovascular disease (ASCVD), the newest guidelines put more focus on individualized risk assessment which necessitates increased participation of laboratory medicine in the prevention and management of ASCVD. This mini-review summarizes key ideas from the new guideline that influence laboratory practice, including the renewed low-density lipoprotein cholesterol (LDL-C) treatment targets in primary and secondary prevention, the use of non-fasting lipids, new calculations of LDL cholesterol, and recommendations on assessing risk-enhancing factors in certain populations to aid the decision on statin and non-statin therapy. The shift in strategies for monitoring and lowering LDL-C has created opportunities for clinical laboratorians to more actively contribute to better identification of individuals at risk for ASCVD and partner with physicians taking care of the patient.


Assuntos
American Heart Association , Análise Química do Sangue/métodos , Cardiologia , Colesterol/sangue , Guias de Prática Clínica como Assunto , Aterosclerose/sangue , Aterosclerose/prevenção & controle , Humanos , Estados Unidos
20.
J Clin Pharm Ther ; 44(4): 632-639, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30963623

RESUMO

WHAT IS KNOWN AND OBJECTIVE: Race and gender disparities in the context of appropriate treatment with lipid-lowering therapies do exist. The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines outlined four groups, three for primary prevention and one for secondary prevention, whom would benefit from statin therapy to target atherosclerotic cardiovascular disease (ASCVD). The application of these recommendations in Filipino women living in the United States is unknown; however, this population is known to have elevated cardiovascular risk. Socio-economic and clinical characteristics that predict statin utilization of this Asian American subgroup need to be explored. METHODS: This was an exploratory analysis of data collected during a cross-sectional study of Filipino-American Women (FAW). The Pooled Cohort equation was used to estimate 10-year ASCVD risk. Bivariate analysis was employed to determine the association between statin treatment and clinical and socio-economic factors. Data were analysed using SAS® 9.4; statistical significance was set at P < 0.05. RESULTS AND DISCUSSION: A total of 384 women (mean age 56.3 years) were included in the original study, and the average 10-year ASCVD risk was 3.5 ± 3.7%. Upon applying the 2013 ACC/AHA guidelines, 97 FAW were categorized into one of the primary prevention groups. Women considered to benefit from a statin based on the guideline criteria but were not prescribed a statin were considered the not statin treated group (n = 55). From the original cohort, 93 FAW reported current statin therapy use and were categorized as statin treated. The clinical characteristics associated with not being statin treated were as follows: untreated blood pressure (P = 0.012), higher diastolic blood pressure (P = 0.015), higher total cholesterol (P < 0.001), higher triglycerides (P = 0.041), higher low-density lipoprotein (P < 0.001) and higher glucose (P = 0.011). The socio-economic factor associated with not being statin treated was having two or more insurance payers (P = 0.005). Overall, this population had a waist circumference and body mass index (BMI) that exceeds guidelines for Asian women (31.5 or 80 cm). WHAT IS NEW AND CONCLUSION: Predictors of statin utilization in FAW are not well documented in the literature. These findings emphasize room for improvement for the prescribing of statins in primary prevention for this study population. Applying culturally appropriate screening strategies to identify cardiovascular risk factors early such as BMI or waist circumference may assist with quantifying patients into one of the statin benefit groups if eligible.


Assuntos
Aterosclerose/induzido quimicamente , Aterosclerose/prevenção & controle , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Adulto , Idoso , American Heart Association , Americanos Asiáticos , Estudos de Coortes , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Humanos , Pessoa de Meia-Idade , Prevenção Primária/métodos , Medição de Risco , Fatores de Risco , Prevenção Secundária/métodos , Estados Unidos
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