Sehestedt Thomas, Jeppesen Jørgen, Hansen Tine W, Rasmussen Susanne, Wachtell Kristian, Ibsen Hans, Torp-Pedersen Christian, Olsen Michael H
Cardiovascular Research Unit, Department of Internal Medicine, Glostrup University Hospital, Glostrup, Denmark.
J Hypertens. 2009 Jun;27(6):1165-71. doi: 10.1097/HJH.0b013e32832af343.
Medical treatment of healthy individuals with high normal blood pressure (BP) is recommended if there is subclinical organ damage (SOD). We examined which markers of SOD to use based on their supplementary prognostic value.
In a population sample of 1968 individuals, aged 41, 51, 61 and 71 years, without diabetes, prior stroke or myocardial infarction, not receiving any cardiovascular, antidiabetic or lipid-lowering medications, we measured urine albumin/creatinine ratio, carotid atherosclerotic plaques, carotid/femoral pulse wave velocity and left ventricular mass index.
During a median follow-up of 12.8 years, the composite endpoint (CEP) of cardiovascular death, nonfatal myocardial infarction and stroke occurred in 153 individuals, of whom 32 had high normal BP. Presence of high normal BP was associated with increased risk of CEP [hazard ratio, 1.8 (95% confidence interval, 1.0-3.1; P = 0.046), optimal BP as reference group, adjusted for age and sex]. In the 337 individuals with high normal BP, using all four markers of SOD increased the sensitivity (number of CEPs in the group in which antihypertensive treatment was indicated divided by total number of CEPs) of the European Society of Hypertension risk classification chart significantly from 47 to 88% (P = 0.001) and the proportion of individuals in whom antihypertensive drug treatment was indicated from 22 to 57% (P < 0.001). Using two of pulse wave velocities of more than 12 m/s, atherosclerotic plaques or urine albumin/creatinine ratio of at least the 90th percentile did not produce significantly worse results. Seventy-five percent of individuals with three or more traditional risk factors had SOD.
In healthy individuals with high normal BP, measuring two of pulse wave velocities, atherosclerotic plaques or urine albumin/creatinine ratio was sufficient to significantly improve risk prediction.
如果存在亚临床器官损害（SOD），则建议对血压略高于正常水平的健康个体进行药物治疗。我们基于其补充预后价值研究了使用哪些SOD标志物。
在一个由1968名年龄分别为41、51、61和71岁的个体组成的人群样本中，这些个体无糖尿病、既往无中风或心肌梗死，未接受任何心血管、抗糖尿病或降脂药物治疗，我们测量了尿白蛋白/肌酐比值、颈动脉粥样硬化斑块、颈动脉/股动脉脉搏波速度和左心室质量指数。
在中位随访12.8年期间，153名个体发生了心血管死亡、非致命性心肌梗死和中风的复合终点（CEP），其中32人血压略高于正常水平。血压略高于正常水平与CEP风险增加相关[风险比，1.8（95%置信区间，1.0 - 3.1；P = 0.046），以最佳血压作为参照组，并根据年龄和性别进行调整]。在337名血压略高于正常水平的个体中，使用所有四个SOD标志物可使欧洲高血压学会风险分类图表的敏感性（建议进行降压治疗的组中的CEP数量除以CEP总数）从47%显著提高到88%（P = 0.001），且建议进行降压药物治疗的个体比例从22%提高到57%（P < 0.001）。使用两个脉搏波速度超过12 m/s、动脉粥样硬化斑块或尿白蛋白/肌酐比值至少处于第90百分位数的指标，结果不会显著变差。75%有三个或更多传统危险因素的个体存在SOD。
在血压略高于正常水平的健康个体中，测量两个脉搏波速度、动脉粥样硬化斑块或尿白蛋白/肌酐比值足以显著改善风险预测。
