Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Am J Hypertens. 2014 Feb;27(2):245-51. doi: 10.1093/ajh/hpt200. Epub 2013 Nov 4.
The independent prognostic value of prehypertension for incident coronary heart disease (CHD) remains unsettled. We examined associations between prehypertension (systolic blood pressure of 130-139.9 and/or diastolic blood pressure of 80-89mm Hg) and incident acute CHD and cardiovascular disease (CVD) death.
The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study includes 30,239 black and white community-dwelling adults aged ≥45 years recruited from 2003 to 2007. Endpoints were centrally adjudicated by experts and included incident nonfatal myocardial infarction (MI), acute CHD (nonfatal and fatal MI), and a composite of nonfatal MI or CVD death. Cox proportional hazards models estimated the hazard ratios (HRs) for these endpoints by blood pressure (BP) categories adjusting for sociodemographics and CHD risk factors.
The 24,388 participants free of CHD at baseline (mean age = 64.1±9.3 years; 58% women; 42% blacks) were followed for a mean of 4.2±1.5 years. The unadjusted HR for incident acute CHD was 1.23 (95% confidence interval (CI) = 0.93-1.64) for prehypertension and 2.28 (95% CI = 1.71-3.04) for hypertension. With full adjustment, the HR for prehypertension remained nonsignificant. The HR for nonfatal MI and for acute CHD death was also nonsignificant. For the combined endpoint (incident fatal and nonfatal MI or CVD death), the unadjusted HR was 1.29 (95% CI = 1.02-1.64) but the adjusted HR was 1.15 (95% CI = 0.91-1.47). Finally, after adjustment for other CHD risk factors, there was no significant interaction of BP with race.
In this sample, prehypertension was not associated with incident acute CHD.
高血压前期对冠心病（CHD）事件的独立预后价值仍未确定。我们研究了高血压前期（收缩压 130-139.9mmHg 和/或舒张压 80-89mmHg）与急性 CHD 和心血管疾病（CVD）死亡的关系。
地理和种族差异中风原因研究（REGARDS）包括 2003 年至 2007 年间招募的 30239 名年龄≥45 岁的黑人和白人社区居民。终点由专家进行中心裁决，包括非致命性心肌梗死（MI）、急性 CHD（非致命性和致命性 MI）和非致命性 MI 或 CVD 死亡的复合终点。Cox 比例风险模型通过血压（BP）类别调整社会人口统计学和 CHD 危险因素，估计这些终点的危险比（HR）。
24388 名基线无 CHD 的参与者（平均年龄=64.1±9.3 岁；58%女性；42%黑人）平均随访 4.2±1.5 年。高血压前期的急性 CHD 发生率未调整 HR 为 1.23（95%置信区间[CI] = 0.93-1.64），高血压为 2.28（95%CI = 1.71-3.04）。经过充分调整，高血压前期的 HR 仍无统计学意义。非致命性 MI 和急性 CHD 死亡的 HR 也无统计学意义。对于复合终点（致命和非致命性 MI 或 CVD 死亡），未调整的 HR 为 1.29（95%CI = 1.02-1.64），但调整后的 HR 为 1.15（95%CI = 0.91-1.47）。最后，在调整其他 CHD 风险因素后，BP 与种族之间没有显著的交互作用。
在本样本中，高血压前期与急性 CHD 事件无关。
