Franklin Stanley S, Pio Jose R, Wong Nathan D, Larson Martin G, Leip Eric P, Vasan Ramachandran S, Levy Daniel
Heart Disease Prevention Program, University of California, C240 Medical Sciences, Irvine, CA 92697, USA.
Circulation. 2005 Mar 8;111(9):1121-7. doi: 10.1161/01.CIR.0000157159.39889.EC. Epub 2005 Feb 21.
Factors leading differentially to the development of isolated diastolic (IDH), systolic-diastolic (SDH), and isolated systolic (ISH) hypertension are poorly understood. We examined the relations of blood pressure (BP) and clinical risk factors to the new onset of the 3 forms of hypertension.
Participants in the Framingham Heart Study were included if they had undergone 2 biennial examinations between 1953 and 1957 and were free of antihypertensive therapy and cardiovascular disease. Compared with optimal BP (SBP <120 and DBP <80 mm Hg), the adjusted hazard ratios (HRs) for developing new-onset IDH over the ensuing 10 years were 2.75 for normal BP, 3.29 for high-normal BP (both P<0.0001), 1.31 (P=0.40) for SDH, and 0.61 (P=0.36) for ISH. The HRs of developing new-onset SDH were 3.32, 7.96, 7.10, and 23.12 for the normal BP, high-normal BP, ISH, and IDH groups, respectively (all P<0.0001). The HRs of developing ISH were 3.26 for normal and 4.82 for high-normal BP (both P<0.0001), 1.39 (P=0.24) for IDH, and 1.69 (P<0.01) for SDH. Increased body mass index (BMI) during follow-up predicted new-onset IDH and SDH. Other predictors of IDH were younger age, male sex, and BMI at baseline. Predictors of ISH included older age, female sex, and increased BMI during follow-up.
Given the propensity for increased baseline BMI and weight gain to predict new-onset IDH and the high probability of IDH to transition to SDH, it is likely that IDH is not a benign condition. ISH arises more commonly from normal and high-normal BP than from "burned-out" diastolic hypertension.
导致单纯舒张期高血压（IDH）、收缩期-舒张期高血压（SDH）和单纯收缩期高血压（ISH）发生差异的因素尚不清楚。我们研究了血压（BP）和临床危险因素与这三种高血压新发病例的关系。
纳入弗雷明汉心脏研究中在1953年至1957年间接受过两次两年一次检查且未接受抗高血压治疗和无心血管疾病的参与者。与最佳血压（收缩压<120且舒张压<80 mmHg）相比，在随后10年中发生新发IDH的校正风险比（HR），正常血压者为2.75，高正常血压者为3.29（均P<0.0001），SDH为1.31（P=0.40），ISH为0.61（P=0.36）。正常血压、高正常血压、ISH和IDH组发生新发SDH的HR分别为3.32、7.96、7.10和23.12（均P<0.0001）。正常血压者发生ISH的HR为3.26，高正常血压者为4.82（均P<0.0001），IDH为1.39（P=0.24），SDH为1.69（P<0.01）。随访期间体重指数（BMI）增加可预测新发IDH和SDH。IDH的其他预测因素为年龄较小、男性以及基线BMI。ISH的预测因素包括年龄较大、女性以及随访期间BMI增加。
鉴于基线BMI增加和体重增加倾向于预测新发IDH，且IDH转变为SDH的可能性很高，IDH可能并非良性疾病。ISH更常见于从正常和高正常血压发展而来，而非源于“消退型”舒张期高血压。
