Nanchahal K, Ashton W D, Wood D A
Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, UK.
J Hypertens. 2000 Jul;18(7):833-41. doi: 10.1097/00004872-200018070-00003.
To examine relationships of normal blood pressure (BP), hypertension and degree of BP control with cardiovascular disease (CVD) risk factors and predicted 10-year risks for coronary heart disease (CHD) and stroke.
Cross-sectional survey.
107 Marks and Spencer retail stores in the UK.
14,077 women, aged 30-64 years, screened for CVD risk factors between 1988 and 1991.
Systolic (SBP) and diastolic (DBP) BP; total, high-(HDL) and low-density lipoprotein (LDL) cholesterol, ratio of total to HDL cholesterol (TC/HDL-C); triglycerides, apolipoprotein A1, apolipoprotein B, lipoprotein (a), glucose, body mass index, antihypertensive medication and predicted risks for CHD and stroke. Hypertension was defined as SBP > or = 140 mmHg and/or DBP > or = 90 mmHg and/or taking anti-hypertensive medication. Subjects were divided into normotensives with optimal (n = 6,599), normal (n = 3,170) and high normal (n = 2,184) BP levels, and hypertensives with adequate BP control (n = 228), untreated (n = 1,729) and inadequate BP control (n = 291).
BP level was associated with other CVD risk factors among both normotensives and hypertensives. Women with inadequately controlled BP had the worst risk profile, followed by untreated hypertensives, those with adequately controlled BP and normotensives. Odds ratios for being in the top quintile of predicted 10-year CHD and stroke risks were 1, 2.7, 4.2, 8.5, 13.0, 18.9 for CHD; 1, 1.1, 5.8, 18.7, 20.6, 756 for stroke, for optimal, normal, high normal, adequate BP control, untreated and inadequate BP control groups respectively.
Untreated hypertensives and women taking anti-hypertensive medication but with BP > or = 140/90 mmHg have the most atherogenic risk factor profiles. Effective management of BP and the associated CVD risk requires a multi-factorial approach, rather than addressing BP control in isolation.
研究正常血压、高血压及血压控制程度与心血管疾病（CVD）危险因素以及冠心病（CHD）和中风的预测10年风险之间的关系。
横断面调查。
英国107家玛莎百货零售店。
1988年至1991年间接受CVD危险因素筛查的14077名30 - 64岁女性。
收缩压（SBP）和舒张压（DBP）；总胆固醇、高密度脂蛋白（HDL）和低密度脂蛋白（LDL）胆固醇、总胆固醇与HDL胆固醇之比（TC/HDL - C）；甘油三酯、载脂蛋白A1、载脂蛋白B、脂蛋白（a）、血糖、体重指数、抗高血压药物以及CHD和中风的预测风险。高血压定义为SBP≥140 mmHg和/或DBP≥90 mmHg和/或服用抗高血压药物。受试者分为血压水平最佳（n = 6599）、正常（n = 3170）和高正常（n = 2184）的正常血压者，以及血压控制良好（n = 228）、未治疗（n = 1729）和血压控制不佳（n = 291）的高血压患者。
在正常血压者和高血压患者中，血压水平均与其他CVD危险因素相关。血压控制不佳的女性风险状况最差，其次是未治疗的高血压患者、血压控制良好的患者和正常血压者。预测10年CHD和中风风险处于最高五分位数的比值比，CHD分别为1、2.7、4.2、8.5、13.0、18.9；中风分别为1、1.1、5.8、18.7、20.6、756，对应最佳、正常、高正常、血压控制良好、未治疗和血压控制不佳组。
未治疗的高血压患者以及服用抗高血压药物但血压≥140/90 mmHg的女性具有最易致动脉粥样硬化的危险因素谱。有效管理血压及相关的CVD风险需要采取多因素方法，而不是孤立地处理血压控制问题。
