Department of Health Science, Lifestyle-Related Disease Prevention Center, Shiga University of Medical Science, Otsu, Shiga, Japan.
J Hypertens. 2012 Dec;30(12):2299-306. doi: 10.1097/HJH.0b013e328359a9f7.
In Western populations, blood pressure (BP) measured at baseline has been reported to predict long-term (over 20 years) risk of mortality from cardiovascular diseases (CVDs). However, corresponding evidence is scarce in Asia where stroke is dominant. We investigated the association between baseline BP and 24-year mortality risk due to CVD, in a representative Japanese general population.
We followed up a nationwide sample of 8592 Japanese, aged 30 years or above without a history of CVD and antihypertensive medication at baseline, for 24 years. Hazard ratios for CVD mortality in BP categories defined according to JCN7 criteria were estimated using Cox model adjusted for potential confounding factors with normal BP treated as the reference category.
We observed 689 CVD deaths. Hazard ratios for CVD mortality were progressively and significantly increased from the category of prehypertension. Population-attributable fraction (PAF) demonstrated that 43 and 48% of CVD and stroke deaths were explained by non-normal BP at baseline. Hazard ratios and PAF were remarkably higher in younger participants (aged 30-59 years) than those in the elderly (aged 60 years or above). Particularly, in younger men, 81% of CVD deaths were explained by non-normal BP. In sensitivity analysis, participants with antihypertensive medication showed the highest hazard ratio for CVD morality compared with the other categories.
BP levels above normal at baseline retained significant relative and absolute risks of CVD and stroke mortality during 24 years. Long-lasting burden of non-normal BP particularly in younger individuals suggests the importance of primary prevention of high BP from younger generation.
在西方人群中，基线时测量的血压已被报道可预测心血管疾病（CVD）的长期（超过 20 年）死亡风险。然而，在以中风为主的亚洲地区，相应的证据很少。我们在日本代表性的一般人群中调查了基线时血压与 24 年 CVD 死亡率风险之间的关系。
我们对基线时无 CVD 病史和未服用降压药物的 8592 名日本成年人进行了全国性样本随访，随访时间为 24 年。使用 Cox 模型，根据 JCN7 标准定义的血压类别调整潜在混杂因素后，估计了 CVD 死亡率的危险比，以正常血压作为参考类别。
我们观察到 689 例 CVD 死亡。从高血压前期开始，CVD 死亡率的危险比逐渐显著增加。人群归因分数（PAF）表明，43%和 48%的 CVD 和中风死亡可归因于基线时的非正常血压。在年龄较小的参与者（年龄 30-59 岁）中，危险比和 PAF 明显高于老年人（年龄 60 岁或以上）。特别是在年轻男性中，81%的 CVD 死亡可归因于非正常血压。在敏感性分析中，与其他类别相比，服用降压药物的参与者的 CVD 死亡率危险比最高。
基线时高于正常的血压水平在 24 年内仍保持着 CVD 和中风死亡的显著相对和绝对风险。非正常血压在年轻人群中持续存在的负担尤其大，这表明从年轻一代开始预防高血压的重要性。
