Klungel O H, Kaplan R C, Heckbert S R, Smith N L, Lemaitre R N, Longstreth W T, Leufkens H G, de Boer A, Psaty B M
Department of Epidemiology, Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, USA.
Stroke. 2000 Feb;31(2):420-4. doi: 10.1161/01.str.31.2.420.
Despite improved control of blood pressure during the last decades in the United States, a considerable proportion of treated hypertensives have not achieved target blood pressure levels. We estimated the proportion of strokes occurring among treated hypertensive patients that may be attributable to uncontrolled blood pressure.
A population-based case-control study was conducted among treated hypertensive members of Group Health Cooperative of Puget Sound. Cases were treated hypertensive patients who sustained a first fatal or nonfatal, ischemic (n=460) or hemorrhagic (n=95) stroke during 1989-1996. Controls were a random sample of stroke-free, treated hypertensive Group Health Cooperative enrollees (n=2966), similar in age to the stroke cases. Multiple measurements of blood pressure and other cardiovascular risk factors were collected from medical records. Logistic regression was used to estimate the risk of ischemic stroke and hemorrhagic stroke associated with uncontrolled blood pressure, defined as diastolic blood pressure >90 mm Hg or systolic blood pressure >140 mm Hg. The fraction of strokes attributable to uncontrolled blood pressure among treated hypertensives was calculated.
Blood pressure was uncontrolled in 78% of ischemic stroke cases, 85% of hemorrhagic stroke cases, and 65% of controls. After adjustment for potential confounders, uncontrolled blood pressure among treated hypertensive patients was moderately associated with ischemic stroke (risk ratio=1.5 [95% CI, 1.2 to 1. 9]) and strongly related to hemorrhagic stroke (risk ratio=3.0 [95% CI, 1.7 to 5.4]). We estimated that 27% (95% CI, 11% to 39%) of the ischemic strokes and 57% (95% CI, 26% to 75%) of the hemorrhagic strokes among treated hypertensive patients were attributable to uncontrolled blood pressure. Overall, 32% (95% CI, 14% to 45%) of all strokes were attributable to uncontrolled blood pressure.
A considerable proportion of incident strokes among treated hypertensive patients may be prevented by achieving control of blood pressure.
尽管在过去几十年里美国的血压控制情况有所改善，但仍有相当一部分接受治疗的高血压患者未达到目标血压水平。我们估计了在接受治疗的高血压患者中，因血压未得到控制而发生的中风比例。
在普吉特海湾健康合作组织中接受治疗的高血压患者中开展了一项基于人群的病例对照研究。病例为在1989年至1996年期间首次发生致命或非致命性缺血性（n = 460）或出血性（n = 95）中风的接受治疗的高血压患者。对照是从无中风的、接受治疗的高血压健康合作组织参保者中随机抽取的样本（n = 2966），年龄与中风病例相似。从医疗记录中收集了多次血压测量值和其他心血管危险因素。采用逻辑回归来估计与血压未得到控制相关的缺血性中风和出血性中风的风险，血压未得到控制定义为舒张压>90 mmHg或收缩压>140 mmHg。计算了接受治疗的高血压患者中因血压未得到控制而导致的中风比例。
78%的缺血性中风病例、85%的出血性中风病例以及65%的对照血压未得到控制。在对潜在混杂因素进行调整后，接受治疗的高血压患者中血压未得到控制与缺血性中风中度相关（风险比 = 1.5 [95% CI，1.2至1.9]），与出血性中风密切相关（风险比 = 3.0 [95% CI，1.7至5.4]）。我们估计，接受治疗的高血压患者中27%（95% CI，11%至39%）的缺血性中风和57%（95% CI，26%至75%）的出血性中风可归因于血压未得到控制。总体而言，所有中风中有32%（95% CI，14%至45%）可归因于血压未得到控制。
通过控制血压，可预防接受治疗的高血压患者中相当一部分新发中风。
