Wallis E J, Ramsay L E, Haq I U, Ghahramani P, Jackson P R
Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Sheffield, UK.
J Hypertens. 2001 Apr;19(4):691-6. doi: 10.1097/00004872-200104000-00005.
To examine the relationship between coronary (CHD) and cardiovascular (CVD) risk in patients with uncomplicated mild hypertension and to determine the accuracy of using CHD risk > or = 15% over 10 years to identify for antihypertensive treatment those patients with CVD risk > or = 20% over 10 years as advised in recent British guidelines.
Comparison of decisions made using CHD risk > or = 15% over 10 years calculated by the Framingham risk function and estimated using a simple table with CVD risk > or = 20% over 10 years.
British population.
People aged 35-64 years with uncomplicated mild systolic hypertension (SBP 140-159 mmHg, n = 624) from the 1995 Scottish Health Survey.
Relationship between CHD and CVD risk. Sensitivity, specificity, positive and negative predictive values (PPV and NPV).
CHD risk 15% over 10 years was equivalent to CVD risk 21% over 10 years. Exact CHD risk > or = 15% over 10 years had sensitivity 79%, specificity 98%, PPV 94% and NPV 93% in detecting CVD risk > or = 20% over 10 years. Use of the table to estimate CHD risk > or = 15% over 10 years gave sensitivity 88%, specificity 90%, PPV 76% and NPV 95%.
CHD risk appears acceptably accurate for targeting treatment in mild hypertension. The risk assessment table, which slightly overestimates CHD risk, was more sensitive in identifying patients with CVD risk > or = 20% over 10 years and may be preferable to using exact CHD risk. European guidelines which suggest targeting treatment for mild hypertension at CHD risk > or = 20% over 10 years are over-conservative compared with British guidelines.
研究单纯性轻度高血压患者的冠心病（CHD）与心血管疾病（CVD）风险之间的关系，并确定按照英国近期指南建议，使用10年冠心病风险≥15%来识别10年心血管疾病风险≥20%的患者以进行抗高血压治疗的准确性。
比较使用弗明汉风险函数计算得出并使用简单表格估算的10年冠心病风险≥15%与10年心血管疾病风险≥20%所做出的决策。
英国人群。
来自1995年苏格兰健康调查的35 - 64岁患有单纯性轻度收缩期高血压（收缩压140 - 159 mmHg，n = 624）的人群。
冠心病与心血管疾病风险之间的关系。敏感度、特异度、阳性和阴性预测值（PPV和NPV）。
10年冠心病风险15%等同于10年心血管疾病风险21%。准确的10年冠心病风险≥15%在检测10年心血管疾病风险≥20%时，敏感度为79%，特异度为98%，阳性预测值为94%，阴性预测值为93%。使用表格估算10年冠心病风险≥15%时，敏感度为88%，特异度为90%，阳性预测值为76%，阴性预测值为95%。
冠心病风险对于轻度高血压的靶向治疗而言准确性尚可接受。风险评估表虽略微高估了冠心病风险，但在识别10年心血管疾病风险≥20%的患者时更为敏感，可能比使用准确的冠心病风险更可取。与英国指南相比，欧洲指南建议针对10年冠心病风险≥20%的轻度高血压进行靶向治疗有些过于保守。
