Li Cairu, Engström Gunnar, Hedblad Bo, Berglund Göran, Janzon Lars
Department of Community Medicine, Malmö University Hospital, Malmö, Sweden.
Stroke. 2005 Apr;36(4):725-30. doi: 10.1161/01.STR.0000158925.12740.87. Epub 2005 Mar 3.
Adequate control of blood pressure (BP) is a cornerstone in stroke prevention. This study explored the risk of stroke in relation to the quality of BP control in a population-based cohort and whether control of hypertension was related to background characteristics of patients.
A total of 27,936 subjects (10,953 men and 16,983 women), 45 to 73 years old, living in Malmö, Sweden participated in the study. Incidence of stroke was followed-up for a mean period of 6 years. Controlled BP was defined as BP <140/90 mm Hg in subjects with pharmacological treatment for hypertension.
In the whole cohort, 16 648 subjects (60%) had hypertension (BP > or =140/90 mm Hg) and 23% of them received treatment. Among treated hypertensives, 88.2% had BP levels > or =140/90 mm Hg and 49.5% had BP levels >or =160/100 mm Hg. During the follow-up, 137 strokes occurred among treated hypertensive subjects. The crude incidence of stroke was 289/100 000 person-year in controlled hypertensive subjects and 705/100,000 person-year in treated hypertensive subjects with BP >or =140/90 mm Hg. It was estimated that approximately 45% of all strokes among subjects with treatment for hypertension might be attributed to uncontrolled BP. In treated hypertensives, the risk of stroke increased significantly with advancing age, current smoking, high level of diastolic BP, and diabetes. In hypertensive subjects without treatment (n=12 819), incidence of stroke was 363/100,000 person-year.
Uncontrolled BP is highly prevalent in patients with pharmacological treatment for hypertension. More than 90% of stroke in this group occurred in those with uncontrolled BP. Adequate hypertension control may prevent a substantial proportion of first-ever stroke among treated hypertensives.
充分控制血压是预防中风的基石。本研究在一个基于人群的队列中探讨了与血压控制质量相关的中风风险,以及高血压控制是否与患者的背景特征有关。
共有27936名年龄在45至73岁之间、居住在瑞典马尔默的受试者(10953名男性和16983名女性)参与了该研究。对中风发病率进行了平均6年的随访。血压得到控制定义为接受高血压药物治疗的受试者血压<140/90 mmHg。
在整个队列中,16648名受试者(60%)患有高血压(血压≥140/90 mmHg),其中23%接受了治疗。在接受治疗的高血压患者中,88.2%的血压水平≥140/90 mmHg,49.5%的血压水平≥160/100 mmHg。在随访期间,接受治疗的高血压患者中发生了137例中风。血压得到控制的高血压患者中风的粗发病率为289/100000人年,血压≥140/90 mmHg的接受治疗的高血压患者中风的粗发病率为705/100000人年。据估计,接受高血压治疗的受试者中,所有中风病例中约45%可能归因于血压未得到控制。在接受治疗的高血压患者中,中风风险随着年龄增长、当前吸烟、舒张压水平高和糖尿病而显著增加。在未接受治疗的高血压受试者(n = 12819)中,中风发病率为363/100000人年。
在接受高血压药物治疗的患者中,血压未得到控制的情况非常普遍。该组中超过90%的中风发生在血压未得到控制的患者中。充分控制高血压可能会预防相当比例的接受治疗的高血压患者首次中风。