From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., D.S.); and Departments of Epidemiology (J.N.B., M.R.I., P.M.), Biostatistics (G.H.), and Medicine (D.A.C., M.M.S.), University of Alabama at Birmingham.
Hypertension. 2014 Sep;64(3):465-71. doi: 10.1161/HYPERTENSIONAHA.114.03565. Epub 2014 Jun 9.
Few data exist on whether healthy lifestyle factors are associated with better prognosis among individuals with apparent treatment-resistant hypertension, a high-risk phenotype of hypertension. The purpose of this study was to assess the association of healthy lifestyle factors with cardiovascular events, all-cause mortality, and cardiovascular mortality among individuals with apparent treatment-resistant hypertension. We studied participants (n=2043) from the population-based Reasons for Geographic and Racial Differences in Stroke (REGARDS) study with apparent treatment-resistant hypertension (blood pressure ≥140/90 mm Hg despite the use of 3 antihypertensive medication classes or the use of ≥4 classes of antihypertensive medication regardless of blood pressure control). Six healthy lifestyle factors adapted from guidelines for the management of hypertension (normal waist circumference, physical activity ≥4 times/week, nonsmoking, moderate alcohol consumption, high Dietary Approaches to Stop Hypertension diet score, and low sodium-to-potassium intake ratio) were examined. A greater number of healthy lifestyle factors were associated with lower risk for cardiovascular events (n=360) during a mean follow-up of 4.5 years. Multivariable-adjusted hazard ratios [HR (95% confidence interval)] for cardiovascular events comparing individuals with 2, 3, and 4 to 6 versus 0 to 1 healthy lifestyle factors were 0.91 (0.68-1.21), 0.80 (0.57-1.14), and 0.63 (0.41-0.95), respectively (P-trend=0.020). Physical activity and nonsmoking were individual healthy lifestyle factors significantly associated with lower risk for cardiovascular events. Similar associations were observed between healthy lifestyle factors and risk for all-cause and cardiovascular mortality. In conclusion, healthy lifestyle factors, particularly physical activity and nonsmoking, are associated with a lower risk for cardiovascular events and mortality among individuals with apparent treatment-resistant hypertension.
关于健康的生活方式因素是否与明显治疗抵抗性高血压（高血压的一种高危表型）患者的预后改善相关，目前仅有少量数据。本研究旨在评估健康生活方式因素与明显治疗抵抗性高血压患者心血管事件、全因死亡率和心血管死亡率之间的关联。我们研究了来自基于人群的地理和种族差异导致中风原因（REGARDS）研究的参与者（n=2043），这些患者有明显的治疗抵抗性高血压（尽管使用了 3 种降压药物类别，或使用了≥4 种降压药物类别，而不管血压控制情况如何，血压仍≥140/90mmHg）。从高血压管理指南中选取了 6 种健康生活方式因素（正常腰围、每周运动≥4 次、不吸烟、适量饮酒、高得舒饮食评分和低钠钾摄入比）进行研究。在平均随访 4.5 年后，有更多健康生活方式因素与心血管事件（n=360）风险降低相关。与 0-1 个健康生活方式因素相比，比较 2、3 和 4-6 个健康生活方式因素的个体心血管事件的多变量调整后危险比（HR[95%置信区间]）分别为 0.91（0.68-1.21）、0.80（0.57-1.14）和 0.63（0.41-0.95）（P趋势=0.020）。体力活动和不吸烟是与心血管事件风险降低显著相关的个别健康生活方式因素。在健康生活方式因素与全因死亡率和心血管死亡率之间也观察到了类似的关联。总之，健康的生活方式因素，特别是体力活动和不吸烟，与明显治疗抵抗性高血压患者心血管事件和死亡率的降低相关。
