Julius S, Jamerson K, Mejia A, Krause L, Schork N, Jones K
Division of Hypertension, University of Michigan Hospitals, Ann Arbor 48109-0356.
JAMA. 1990 Jul 18;264(3):354-8.
The Tecumseh project investigates the evolution of hypertension in a healthy population. Of 946 subjects aged 18 through 38 years, 124 had clinic blood pressure readings higher than 140/90 mm Hg (the mean for borderline hypertensive subjects was 130/94 mm Hg). Compared with normotensive subjects, borderline hypertensive subjects had higher home blood pressures (mean, 12/7 mm Hg higher). Their childhood and postpubertal blood pressures were elevated (6/4 mm Hg higher than normal at age 6 years and 12/7 mm Hg higher than normal at age 21 years), and hypertensive target organ changes were detected. Borderline hypertensive subjects also had elevated minimal forearm resistance (0.22 U higher than normal), decreased stroke index (1.8 mL/m2 lower than normal), and impaired ventricular diastolic relaxation (mitral Doppler peak early diastolic blood flow [E] to peak late diastolic blood flow [A] ratio 0.13 lower than normal). Borderline hypertensive subjects had significant abnormalities in other coronary risk factors (cholesterol levels were 0.39 mmol/L higher, triglyceride levels were 0.45 mmol/L higher, high-density lipoprotein levels were 0.08 mmol/L lower, insulin levels were 38 pmol/L higher, and 16.5% more of them were overweight). Borderline hypertension is neither transient nor innocuous. Its association with other predictors of atherosclerosis calls for clinical attention.
蒂卡姆西项目研究了健康人群中高血压的演变情况。在946名年龄在18至38岁之间的受试者中，有124人的诊所血压读数高于140/90毫米汞柱（临界高血压受试者的平均值为130/94毫米汞柱）。与血压正常的受试者相比，临界高血压受试者的家庭血压更高（平均高12/7毫米汞柱）。他们儿童期和青春期后的血压升高（6岁时比正常高6/4毫米汞柱，21岁时比正常高12/7毫米汞柱），并且检测到高血压靶器官改变。临界高血压受试者的最小前臂阻力也升高（比正常高0.22单位），中风指数降低（比正常低1.8毫升/平方米），心室舒张功能受损（二尖瓣多普勒舒张早期血流峰值[E]与舒张晚期血流峰值[A]之比比正常低0.13）。临界高血压受试者在其他冠心病危险因素方面有显著异常（胆固醇水平高0.39毫摩尔/升，甘油三酯水平高0.45毫摩尔/升，高密度脂蛋白水平低0.08毫摩尔/升，胰岛素水平高38皮摩尔/升，超重的比例高16.5%）。临界高血压既不是短暂的，也不是无害的。它与动脉粥样硬化的其他预测因素的关联值得临床关注。
