Liszka Heather A, Mainous Arch G, King Dana E, Everett Charles J, Egan Brent M
Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
Ann Fam Med. 2005 Jul-Aug;3(4):294-9. doi: 10.1370/afm.312.
The Seventh Report of the Joint National Commission (JNC 7) on High Blood Pressure established prehypertension (120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic) as a new risk category. We aim to determine the risk of major cardiovascular events associated with blood pressure in the prehypertensive range in a longitudinal, population-based cohort.
Analyses were conducted on participants in the National Health and Nutrition Examination Survey I (1971-1975) observed for 18 years for major cardiovascular disease events. Cox proportional hazard ratios were calculated to assess relative risk of cardiovascular disease, including stroke, myocardial infarction, and heart failure, in participants with prehypertension and normal blood pressure (<120/80 mm Hg).
Prehypertension was associated with increased risk for cardiovascular disease (1.79 [95% confidence interval (CI) 1.40-2.24]) in unadjusted analysis. After adjustment for cardiovascular risk factors, the relationship of prehypertension to cardiovascular disease was diminished but persisted (1.32 [95% CI 1.05-1.65]). Ninety-three percent of prehypertensive individuals had at least 1 cardiovascular risk factor. Low prehypertension (120-129/80-84 mm Hg) was associated with increased cardiovascular disease in unadjusted analyses (1.56 [95% CI 1.23-1.98]) but was not statistically significant in adjusted analyses (1.24 [95% CI 0.96-1.59]). High-normal blood pressure (130-139/85-89 mm Hg) remained a predictor of cardiovascular disease in unadjusted (2.13 [95% CI 1.64-2.76]) and adjusted (1.42 [95% CI 1.09-1.84]) analyses.
In a longitudinal, population-based, US cohort, prehypertension was associated with increased risk of major cardiovascular events independently of other cardiovascular risk factors. These findings, along with the presence of cardiovascular risk factors in the majority of participant sample with prehypertension, support recommendations for physicians to actively target lifestyle modifications and multiple risk reduction in their prehypertensive patients.
美国国家联合委员会（JNC 7）关于高血压的第七次报告将高血压前期（收缩压120至139毫米汞柱或舒张压80至89毫米汞柱）确立为一个新的风险类别。我们旨在确定在一个基于人群的纵向队列中，高血压前期范围内的血压与主要心血管事件风险之间的关系。
对第一次全国健康和营养检查调查（1971 - 1975年）的参与者进行了18年的观察，以了解主要心血管疾病事件。计算Cox比例风险比，以评估高血压前期和血压正常（<120/80毫米汞柱）的参与者患心血管疾病的相对风险，包括中风、心肌梗死和心力衰竭。
在未经调整的分析中，高血压前期与心血管疾病风险增加相关（1.79 [95%置信区间（CI）1.40 - 2.24]）。在对心血管危险因素进行调整后，高血压前期与心血管疾病的关系减弱但仍然存在（1.32 [95% CI 1.05 - 1.65]）。93%的高血压前期个体至少有1种心血管危险因素。轻度高血压前期（120 - 129/80 - 84毫米汞柱）在未经调整的分析中与心血管疾病风险增加相关（1.56 [95% CI 1.23 - 1.98]），但在调整后的分析中无统计学意义（1.24 [95% CI 0.96 - 1.59]）。血压正常高值（130 - 139/85 - 89毫米汞柱）在未经调整（2.13 [95% CI 1.64 - 2.76]）和调整（1.42 [95% CI 1.09 - 1.84]）的分析中仍然是心血管疾病的一个预测因素。
在一个基于美国人群的纵向队列中，高血压前期与主要心血管事件风险增加相关，且独立于其他心血管危险因素。这些发现，以及大多数高血压前期参与者样本中存在心血管危险因素，支持医生积极针对其高血压前期患者进行生活方式改变和多种风险降低措施的建议。
