van den Hoogen P C, Feskens E J, Nagelkerke N J, Menotti A, Nissinen A, Kromhout D
Department of Chronic Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
N Engl J Med. 2000 Jan 6;342(1):1-8. doi: 10.1056/NEJM200001063420101.
Elevated blood pressure is known to be a risk factor for death from coronary heart disease (CHD). However, it is unclear whether the risk of death from CHD in relation to blood pressure varies among populations.
In six populations in different parts of the world, we examined systolic and diastolic blood pressures and hypertension in relation to long-term mortality from CHD, both with and without adjustment for variability in blood pressure within individual subjects. Blood pressure was measured at base-line in 12,031 men (age range, 40 to 59 years) who were free of CHD. During 25 years of follow-up, 1291 men died from CHD.
At systolic and diastolic blood pressures of about 140 and 85 mm Hg, respectively, 25-year rates of mortality from CHD (standardized for age) varied by a factor of more than three among the populations. Rates in the United States and northern Europe were high (approximately 70 deaths per 10,000 person-years), but rates in Japan and Mediterranean southern Europe were low (approximately 20 deaths per 10,000 person-years). However, the relative increase in 25-year mortality from CHD for a given increase in blood pressure was similar among the populations. The overall unadjusted relative risk of death due to CHD was 1.17 (95 percent confidence interval, 1.14 to 1.20) per 10 mm Hg increase in systolic pressure and 1.13 (95 percent confidence interval, 1.10 to 1.15) per 5 mm Hg increase in diastolic pressure, and it was 1.28 for each of these increments after adjustment for within-subject variability in blood pressure.
Among the six populations we studied, the relative increase in long-term mortality due to CHD for a given increase in blood pressure is similar, whereas the absolute risk at the same level of blood pressure varies substantially. If the absolute risk of CHD is used as an indication for antihypertensive therapy, these findings will have major implications for treatment in different parts of the world.
已知血压升高是冠心病（CHD）死亡的一个危险因素。然而，冠心病死亡风险与血压的关系在不同人群中是否存在差异尚不清楚。
在世界不同地区的六个人群中，我们研究了收缩压和舒张压以及高血压与冠心病长期死亡率的关系，同时对个体受试者血压的变异性进行了调整和未调整分析。对12031名无冠心病的男性（年龄范围40至59岁）进行了基线血压测量。在25年的随访期间，有1291名男性死于冠心病。
在收缩压和舒张压分别约为140和85 mmHg时，冠心病25年死亡率（年龄标准化）在不同人群中相差三倍多。美国和北欧的死亡率较高（每10000人年约70例死亡），而日本和地中海地区南欧的死亡率较低（每10000人年约20例死亡）。然而，血压每升高一定幅度，冠心病25年死亡率的相对增加在不同人群中相似。收缩压每升高10 mmHg，冠心病死亡的总体未调整相对风险为1.17（95%置信区间1. 14至1.20），舒张压每升高5 mmHg，相对风险为1.13（95%置信区间1.10至1.15），在对血压的个体内变异性进行调整后，这些增幅中的每一个的相对风险为1.28。
在我们研究的六个人群中，血压每升高一定幅度，冠心病导致的长期死亡率的相对增加相似，而相同血压水平下的绝对风险差异很大。如果将冠心病的绝对风险用作抗高血压治疗的指征，这些发现将对世界不同地区的治疗产生重大影响。
