新的心血管风险工具可以指导谁需要高血压药物治疗

多年来, the question of whether to take medication to lower high blood pressure had been partly answered by a tool that calculated someone's 10-year risk of having a heart attack or 中风.

但是新的方程, 考虑到10年和30年心血管疾病的预测风险, 建议即使短期风险很低, 对一些人来说，长期风险仍然很高, 周一发表在该杂志上的一项研究显示 高血压.

"It turns out a lot of people have a low risk for heart attack and 中风 over 10 years but a high risk over the next 30 years,”医生说。. 保罗Muntner, the study's lead author and a visiting professor at the University of Alabama at Birmingham. "So, our conclusion is that it may be worthwhile for people to understand the risk for both 10 and 30 years when considering whether to start taking medication."

近一半的美国人.S. 成年人有高血压, 也叫高血压, a condition that occurs when the force of blood flowing through a person's arteries is too strong. 随着沙巴足球体育平台的推移，这会破坏血管壁，导致心脏病发作, 中风, 心脏衰竭, 肾脏疾病和其他健康问题.

当收缩压, 或者最上面的数, 是130-139毫米汞柱(mmHg)还是舒张压, 或者最下面的数, 80-89毫米汞柱, 这是1期高血压. Stage 2 hypertension is diagnosed when the systolic number is 140 mmHg or higher or the diastolic number is 90 mmHg or higher.

Healthy lifestyle changes and medication are recommended for all adults with stage 2 hypertension. 第一阶段, the 2017 美国心脏协会 and American College of Cardiology blood pressure guidelines recommend taking into account both blood pressure level and risk of atherosclerotic cardiovascular disease, 其中包括动脉壁上的斑块积聚, when deciding whether to initiate blood pressure-lowering medications alongside lifestyle changes.

但是如何确定患心血管疾病的风险已经发生了变化. 根据2017年的指导方针, atherosclerotic cardiovascular disease risk was considered high if a person met one or more of five conditions. 包括65岁及以上, 患有糖尿病, 慢性肾病, a history of cardiovascular disease or a 10% or greater risk of having a heart attack or 中风 within 10 years, 通过合并队列方程来衡量, 或电脑.

PCEs estimate a person's 10-year risk for heart attack and 中风 based on risk factors that include their age, 性别, 比赛, 胆固醇水平, 收缩压, 以及他们是否服用降血压药物, 有糖尿病或吸烟. 这些方程是根据20世纪80年代到21世纪初的数据推导出来的.

Since then, new research and treatment advances have emerged that could affect the risk calculations. 例如, 研究人员现在了解到高血压也会增加患心力衰竭的风险, 不包括在pce中的结果. 以及他汀类药物的使用, 一类降胆固醇药物, 已经普及了, 在一定程度上降低了许多人的心血管风险.

因此，在2023年，美国心脏协会发布了一份 一套新的心血管风险预测方程被称为预防. The new calculator predicts the risk of 心脏衰竭 in addition to the risk of plaque-related cardiovascular disease over the next 10 years in people ages 30 to 79 and over the next 30 years in people ages 30 to 59.

这种新工具结合了肾脏功能, 血糖水平和降胆固醇药物的使用. 它还考虑到健康的社会决定因素，如收入, 教育, 就业, 一个人住在哪里, 无论他们是否有交通工具，还是住在拥挤的家庭或单亲家庭. 防止计算 也有性别特异性，不包括种族.

"Race was removed as a variable since 比赛 is a social construct, not a biological factor,”医生说。. 妮娅·施旺·米切尔, an associate professor of general internal medicine at Duke University School of Medicine in Durham, 北卡罗莱纳. “prevention更准确，因为它使用的是最新的数据."

在新的研究中, researchers compared 10-year cardiovascular disease risks using both types of risk equations for adults 30 to 79 with stage 1 hypertension. They also calculated the 30-year risk for adults with high blood pressure who were 30 to 59 years old.

研究结果表明，在1,703名成人1期高血压患者, 平均10年患心脏病或中风的风险是5.使用PCE工具的比例为4%，而使用PCE工具的比例为2%.9%使用预防计算器.

然而，当计算出未来30年的风险时，情况就截然不同了.

Participants under age 60 with stage 1 hypertension who had a high 10-year risk of heart attack or 中风 as calculated by the PCE tool faced a high 30-year risk of heart attack, 中风 or 心脏衰竭 using PREVENT – even if PREVENT had found their 10-year risk to be low.

The higher 30-year risk suggests blood pressure-lowering medication in addition to lifestyle changes might be beneficial in some cases, 即使10年的风险很低, Muntner说.

"There may be value in having a discussion between patients and health professionals about individual risks for having a heart attack, 在未来10年和30年内中风或心力衰竭, because early treatment to lower blood pressure has big effects on lowering the risks of developing heart disease over a person's lifetime,他说.

药物并不是降低血压的唯一方法，也不一定总是必要的, Muntner说. “所有的人, 在开始服用降血压药物之前, 是否应该尝试改变生活方式，比如减少盐的摄入量, 加强锻炼, 如果他们超重就减肥，减少饮酒. 这些都是众所周知的可以降低血压的生活方式因素."

不吸烟, 健康饮食, 保证充足的睡眠, lowering 胆固醇水平 if they are too high and reducing stress can also help reduce blood pressure, 根据美国心脏协会.

“预防比事后处理后果要好得多,米切尔说。, 谁没有参与这项新研究. "高血压 is called 'the silent killer' because some people don't feel it when their blood pressure is too high until it's too late."

知道他们30年内心脏病发作的风险, 中风 or 心脏衰竭 might motivate people to make these changes or take blood pressure-lowering medication if lifestyle changes alone aren't enough, Muntner说.

“我们需要对(预测的)风险保持透明, so patients have all the information and so they can be involved in the decision about what to do,他说. “医生可以提供建议，但最终做决定的是病人."