心血管

JNC8高血压指南或致部分人群高血压治疗不足

作者:小田 译 来源:医学论坛网 日期:2015-08-04
导读

         美国预防、检测、评估和治疗高血压委员会(JNC)8专家组提高了血压控制目标,推荐60岁以上人群收缩压目标为≤150 mm Hg。这些指南可能不同程度地影响黑种人和女性人群。因此,来自布莱根妇女医院的JoAnne M. Foody博士等试图从两个写作小组概述批评的准则提供了专家意见。

        美国预防、检测、评估和治疗高血压委员会(JNC)8专家组提高了血压控制目标,推荐60岁以上人群收缩压目标为≤150 mm Hg。这些指南可能不同程度地影响黑种人和女性人群。因此,来自布莱根妇女医院的JoAnne M. Foody博士等试图从两个写作小组概述批评的准则提供了专家意见。

        文章分为三部分,分别为高血压指南的介绍和历史展望、来自黑人心脏病专家和在黑人患者中治疗高血压的临床专家相关性报告、来自女性心血管健康工作组的报告。

        作者在文章第一部分讨论了JNC 8专家组提出其推荐建议的证据,并描述了正在无慢性肾病(CKD)或糖尿病、60岁以上人群中开展的研究。

        在文章第二部分,作者批判了JNC 8并指出,根据高度选择的临床试验得出的推荐建议是有缺陷的,那些临床试验对于广大人群不具代表性意义,并可能在实际中造成某些人群高血压治疗的不足。同时,女性心血管健康工作组强调,因为高血压妇女在≥60岁年龄组的代表不成比例,所以JNC 8指南的推荐建议潜在恶化了这种差距,尤其是在心衰、房颤、卒中和CKD风险最高的老年非裔美国人群中。

        最后,作者在文中表示坚决不同意2014年JNC8高血压指南关于升高无慢性肾病(CKD)或糖尿病的老年人群起始药物降压临界值为收缩压≤150 mm Hg的推荐建议。

        参考文献:JoAnne M. Foody, et al.ACC.The 2014 Hypertension Recommendations From the 8th JNC Committee Panel Members Raise Concern for Elderly Black and Female Populations

        Jul 08, 2015 | Fatima Rodriguez, MD; JoAnne M. Foody, MD, F.A.C.C.

The 2014 Hypertension Recommendations From the 8th JNC Committee Panel Members Raise Concern for Elderly Black and Female Populations
Jul 08, 2015   |  Fatima Rodriguez, MD; JoAnne M. Foody, MD, F.A.C.C.
Editor's Note: This Article Review was written while JoAnne M. Foody, MD, FACC was employed at Brigham and Women's Hospital. Her disclosures were updated at the time of submission.
Commentary based on Krakoff LR, Gillespie RL, Ferdinand KC, et al. 2014 hypertension recommendations from the eighth joint national committee panel members raise concerns for elderly black and female populations. J Am Coll Cardiol 2014;64:394-402.
Background and Objective
A report from panel members appointed to the Eight Joint National Committee (JNC 8) recommended a major paradigm shift in blood pressure (BP) control targets, with goals of systolic BP (SBP) ≤150 mm Hg for adults over 60 years of age.These guidelines may disproportionately impact the black population and women.This report, therefore, sought to provide expert opinion from two writing groups outlining criticisms to the guidelines.
Methods
The state-of-the art manuscript is divided into three sections – an introduction and historical perspective on hypertension guideline reports,a report from the Association of Black Cardiologists (ABC) and clinical specialists in the treatment of hypertension in black patients, and a report from the Working Group on Women's Cardiovascular Health.
Results
The first section of the paper discusses the evidence that the JNC 8 used to make its recommendations and describes ongoing trials in patients over 60 years of age without diabetes or chronic kidney disease (CKD).In the second section of the paper, the ABC outlines the criticisms of the JNC 8,citing that evidence used in formulating the recommendations are flawed by the inclusion of highly selected clinical trials,which are not representative of broader populations and may in factlead to under-treatment of hypertension in certain populations.Similarly, the Working Group on Women's Cardiovascular Health highlight that since women with hypertension are disproportionately represented in the ≥60 years of age group,the JNC 8 recommendations have the potential to worsen disparities, particularly among older African American women who are the highest risk for heart failure, atrial fibrillation, stroke, and CKD.r
Conclusion
The authors conclude by strongly disagreeing with the JNC 8 2014 recommendations to raise the threshold to initiate pharmacologic BP treatment at SBP ≤150 mm Hg for older adults without CKD or diabetes.

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