Stamler J, Neaton J D, Wentworth D N
Department of Community Health and Preventive Medicine, Northwestern University Medical School, Chicago, Illinois 60611.
Hypertension. 1989 May;13(5 Suppl):I2-12. doi: 10.1161/01.hyp.13.5_suppl.i2.
Among the 356,222 men screened for the Multiple Risk Factor Intervention Trial who had no history of hospitalization for heart attack at entry, more than 2,000 coronary deaths occurred during 6 years of follow-up. With this large data set, detailed cross-tabulations clearly and simply showed the strong graded relation between blood pressure and coronary heart disease death. This risk gradient was evident in each of five age groups ranging from 35 to 57 years and for levels of diastolic blood pressure ranging from less than 75 mm Hg to greater than 115 mm Hg. Systolic blood pressure was more strongly associated with coronary heart disease death than was diastolic blood pressure, and isolated systolic blood pressure elevation was found to be an important risk factor in these middle-aged men. The risk of coronary death was increased among hypertensive men who had elevated serum cholesterol levels or who smoked cigarettes. Because less than 10% of hypertensive men had cholesterol levels in the lowest quintile (below 182 mg/dl) and were nonsmokers, a multi-intervention approach for the large majority of hypertensive persons is clearly indicated. Risks of death were also substantially increased among those hypertensive men who already had end-organ damage, emphasizing the importance of early treatment to prevent such damage. These findings have implications for the design of prevention trials and clinical practice, as it is clear that systolic as well as diastolic blood pressure should be considered in treating hypertensive patients. Additionally, treatment goals should be directed at preventing not only death but many other morbid events, clinical and subclinical, that are associated with elevated blood pressure and that are preventable with appropriate treatment.
在参与多重危险因素干预试验的356,222名男性中，这些人在入组时没有心脏病发作住院史，在6年的随访期间发生了2000多例冠心病死亡。利用这个庞大的数据集，详细的交叉表清晰而简单地显示了血压与冠心病死亡之间的强烈分级关系。这种风险梯度在35至57岁的五个年龄组中的每一组以及舒张压水平从低于75毫米汞柱到高于115毫米汞柱的范围内都很明显。收缩压与冠心病死亡的关联比舒张压更强，并且发现单纯收缩压升高是这些中年男性的一个重要危险因素。血清胆固醇水平升高或吸烟的高血压男性发生冠心病死亡的风险增加。由于不到10%的高血压男性胆固醇水平处于最低五分位数（低于182毫克/分升）且不吸烟，显然表明对绝大多数高血压患者应采取多干预方法。那些已经有靶器官损害的高血压男性的死亡风险也大幅增加，这强调了早期治疗以预防此类损害的重要性。这些发现对预防试验的设计和临床实践具有启示意义，因为很明显在治疗高血压患者时应同时考虑收缩压和舒张压。此外，治疗目标不仅应针对预防死亡，还应针对预防许多其他与血压升高相关且可通过适当治疗预防的临床和亚临床病态事件。
