Division of Health and Nutrition Examination Survey, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA.
Am J Hypertens. 2010 Jan;23(1):38-45. doi: 10.1038/ajh.2009.191. Epub 2009 Oct 22.
Clinical trials have provided convincing evidence that blood pressure (BP) lowering treatment reduces the risk of cardiovascular disease (CVD) and total mortality. The objective of this study was to examine the association of hypertension treatment, control, and BP indexes with all-cause and cardiovascular mortality among US adults with hypertension.
Persons aged > or =18 years from the Third National Health and Nutrition Examination Survey (NHANES III) were identified as hypertensives based on a BP > or =140/90 mm Hg or current treatment for hypertension. Vital status in 2006 was ascertained by passive follow-up using the National Death Index. Cox regression models were used to assess correlates of survival.
At baseline, 52% of hypertensive adults reported currently taking prescription medicine for high BP and 38% of treated persons had BP controlled. Compared to treated controlled hypertensives, treated uncontrolled hypertensives had a 1.57-fold (95% confidence interval (CI) 1.28-1.91) and 1.74-fold (95% CI 1.36-2.22) risk of all-cause and cardiovascular mortality; untreated hypertensives had a 1.34-fold (95% CI 1.12-1.62) and 1.37-fold (95% CI 1.04-1.81) risk of all-cause and cardiovascular mortality, respectively. The association persisted after further excluding persons with pre-existing hypertension comorbidities. Mortality risk was linearly increased with systolic BP (SBP), pulse pressure (PP), and mean arterial pressure (MBP), whereas diastolic BP (DBP) was not a significant predictor of cardiovascular mortality overall. No significant associations were observed between drug classes and mortality risk.
This study indicates that uncontrolled and untreated hypertension was associated with increased risk of total and cardiovascular mortality among the general hypertensive population.
临床试验提供了令人信服的证据，表明降压治疗可降低心血管疾病（CVD）和全因死亡率的风险。本研究的目的是检查美国高血压患者中高血压治疗、控制和血压指标与全因和心血管死亡率的关系。
根据血压>或=140/90mmHg 或目前高血压治疗，从第三次国家健康和营养检查调查（NHANES III）中确定年龄>或=18 岁的人患有高血压。2006 年的生存状态通过国家死亡索引的被动随访来确定。使用 Cox 回归模型评估生存的相关性。
基线时，52%的高血压成年人报告目前正在服用处方降血压药，38%的治疗患者血压得到控制。与治疗控制的高血压患者相比，治疗未控制的高血压患者全因死亡率和心血管死亡率的风险分别增加 1.57 倍（95%置信区间 1.28-1.91）和 1.74 倍（95%置信区间 1.36-2.22）；未经治疗的高血压患者全因死亡率和心血管死亡率的风险分别增加 1.34 倍（95%置信区间 1.12-1.62）和 1.37 倍（95%置信区间 1.04-1.81）。进一步排除有高血压合并症的患者后，这种相关性仍然存在。收缩压（SBP）、脉压（PP）和平均动脉压（MBP）与死亡率呈线性增加，而舒张压（DBP）总体上不是心血管死亡率的显著预测因素。药物类别与死亡率风险之间没有观察到显著相关性。
本研究表明，未经控制和未经治疗的高血压与一般高血压人群的全因和心血管死亡率风险增加有关。
