Wang J G, Staessen J A, Fagard R, Gong L, Liu L
Hypertension Division, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, People's Republic of China.
J Hypertens. 2001 Feb;19(2):187-92. doi: 10.1097/00004872-200102000-00004.
To examine the health risks associated with smoking and blood pressure in Chinese hypertensive patients and to compare the benefit of antihypertensive drug treatment with the risk attributable to smoking.
We used multiple Cox regression to correlate outcome with blood pressure and smoking status in 2284 older (aged > or = 60 years) patients enrolled in the Systolic Hypertension in China (Syst-China) Trial (systolic/diastolic blood pressure > or = 160/< 95 mmHg).
Median follow-up was 3.0 years. After adjustment for sex, age, active antihypertensive treatment and various entry characteristics, the relative hazard rates associated with smoking more than 20 cigarettes per day were 2.04 (P = 0.04), 4.66 (P < 0.001) and 4.74 (P = 0.002) for all-cause, noncardiovascular and cancer mortality, respectively. With similar adjustments applied, the relative hazard rates for total (fatal and non-fatal) stroke associated with smoking 10-20 and more than 20 cigarettes per day were 1.78 (P = 0.04) and 2.23 (P = 0.03), respectively. Furthermore, both smoking and systolic blood pressure were associated with higher risk of stroke. Compared with the overall risk in the whole group, treating 1,000 patients for 5 years prevented 40 [95% confidence interval (CI), 5-75] strokes in smokers as well as never smokers. Prognosis in never smokers and past smokers was similar. Quitting smoking had the potential to prevent 51 (95% CI, -21 to 122) strokes in untreated hypertensive patients and to prevent 45 (95% CI, - 14 to 104) additional strokes in treated patients, over and above the effects of antihypertensive treatment. If, in addition to stroke, non-cardiovascular mortality was also accounted for, the estimated absolute benefit of quitting smoking increased to 69 (95% CI, -18 to 155) and 97 (95% CI, 23-171) events in the untreated and the treated group, respectively.
In elderly Chinese patients, smoking was a risk factor for all-cause, non-cardiovascular and cancer mortality, as well as fatal and non-fatal stroke. The potential benefits of antihypertensive treatment and quitting smoking were approximately similar. In our view, these findings are important in terms of public health policies and health economics.
研究中国高血压患者吸烟与血压相关的健康风险，并比较降压药物治疗的益处与吸烟所致风险。
我们采用多重Cox回归分析，将中国收缩期高血压试验（Syst-China试验，收缩压/舒张压≥160/<95 mmHg）纳入的2284名老年（年龄≥60岁）患者的结局与血压及吸烟状况进行关联分析。
中位随访时间为3.0年。在对性别、年龄、积极降压治疗及各种入组特征进行校正后，每日吸烟超过20支者全因死亡、非心血管疾病死亡和癌症死亡的相对风险率分别为2.04（P = 0.04）、4.66（P < 0.001）和4.74（P = 0.002）。进行类似校正后，每日吸烟10 - 20支和超过20支者总的（致死性和非致死性）卒中的相对风险率分别为1.78（P = 0.04）和2.23（P = 0.03）。此外，吸烟和收缩压均与卒中风险升高相关。与整个组的总体风险相比，对1000例患者治疗5年可预防吸烟者和从不吸烟者40例[95%置信区间（CI），5 - 75]卒中。从不吸烟者和既往吸烟者的预后相似。戒烟有可能使未治疗的高血压患者预防51例（95% CI，-21至122）卒中，并使已治疗患者在降压治疗效果之外额外预防45例（95% CI，-14至104）卒中。如果除卒中外，还考虑非心血管疾病死亡，则戒烟的估计绝对益处分别增至未治疗组69例（95% CI，-18至155）和已治疗组97例（95% CI，23 - 171）事件。
在中国老年患者中，吸烟是全因死亡、非心血管疾病死亡、癌症死亡以及致死性和非致死性卒中的危险因素。降压治疗和戒烟的潜在益处大致相似。我们认为，这些发现对于公共卫生政策和健康经济学而言具有重要意义。
