用欧洲高血压学会的风险图表与 SCORE 在普通人群中的风险评分进行风险分层。

Risk stratification with the risk chart from the European Society of Hypertension compared with SCORE in the general population.

机构信息

Cardiovascular Research Unit, Department of Internal Medicine, Glostrup University Hospital, Denmark.

出版信息

J Hypertens. 2009 Dec;27(12):2351-7. doi: 10.1097/HJH.0b013e328330e90a.

DOI:10.1097/HJH.0b013e328330e90a

PMID:19915482

Abstract

OBJECTIVE

The risk chart from the European Society of Hypertension (ESH) and Systemic Coronary Risk Evaluation (SCORE) from the European Society of Cardiology (ESC) are equally recommended tools for risk stratification. However, ESH risk chart recommends measuring subclinical organ damage, whereas SCORE is based on traditional risk factors. We wanted to compare the predictive performance of the two charts.

METHODS

In a Danish population sample of 1344 individuals aged 41, 51, 61 and 71 years without known diabetes, prior stroke or myocardial infarction, not receiving cardiovascular, antidiabetic or lipid-lowering medications and with higher than optimal blood pressure (> or =120/80 mmHg), we measured traditional risk factors and subclinical organ damage. The endpoints were cardiovascular death and a composite of cardiovascular death, nonfatal myocardial infarction and stroke (CEP).

RESULTS

During the following 12.8 years cardiovascular death and CEP occurred in 71 and 132 patients, respectively. Forty-two percent had unrecognized hypertension. The sizes and characteristics of the populations in the different risk categories of the charts varied considerably as ESH risk chart allocated 368 patients to higher-risk categories than SCORE (P < 0.001). These patients were younger, with higher blood pressure and less frequently male smokers. However, ESH risk chart agreed with ESC guidelines for antihypertensive treatment using SCORE in 89% (634/713) of the patients recommended treatment and produced similar sensitivities (79 vs. 79%), specificities (46 vs. 50%), positive (14 vs. 15%) and negative (95 vs. 96%) predictive values for CEP.

CONCLUSION

Although SCORE did not use subclinical organ damage, the guidelines by ESH and ESC using SCORE recommended antihypertensive treatment in almost the same patients.

摘要

目的

欧洲高血压学会（ESH）的风险图表和欧洲心脏病学会（ESC）的系统性冠状动脉风险评估（SCORE）是同样推荐的风险分层工具。然而，ESH 风险图表建议测量亚临床器官损伤，而 SCORE 则基于传统风险因素。我们想比较这两种图表的预测性能。

方法

在一个丹麦人群样本中，有 1344 名年龄在 41、51、61 和 71 岁、无已知糖尿病、无中风或心肌梗死病史、未接受心血管、抗糖尿病或降脂药物治疗且血压高于最佳水平（>或=120/80mmHg）的个体中，我们测量了传统的风险因素和亚临床器官损伤。终点是心血管死亡和心血管死亡、非致死性心肌梗死和中风的复合终点（CEP）。

结果

在随后的 12.8 年中，有 71 名和 132 名患者分别发生了心血管死亡和 CEP。42%的患者患有未被识别的高血压。图表中不同风险类别的人群的规模和特征差异很大，ESH 风险图表将 368 名患者分配到更高的风险类别，而 SCORE 则为 132 名（P<0.001）。这些患者更年轻，血压更高，男性吸烟者比例较低。然而，ESH 风险图表在建议治疗的 713 名患者中的 89%（634 名）与 ESC 指南使用 SCORE 治疗高血压一致，并产生了相似的敏感性（79%对 79%）、特异性（46%对 50%）、阳性预测值（14%对 15%）和阴性预测值（95%对 96%）。