Franklin Stanley S, Wong Nathan D
Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA, USA.
Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA, USA.
Glob Heart. 2013 Mar;8(1):49-57. doi: 10.1016/j.gheart.2012.12.004. Epub 2013 Mar 15.
This is a historical review of the contribution of the Framingham Heart Study to our understanding of the epidemiology of blood pressure (BP) and cardiovascular disease (CVD). Framingham investigators initially explored the epidemiological relationship of various BP components to coronary heart disease in men and women and how this risk is further modified by age, that is, how diastolic blood pressure (DBP) is the stronger predictor of coronary heart disease risk in young people versus systolic blood pressure (SBP) in middle-aged and elderly people. Framingham investigators then examined the natural history of various BP components over a 30-year follow-up in normotensive and untreated hypertensive individuals and showed how this provides hemodynamic insights into the importance of pulse pressure as a marker of large artery stiffness in middle-aged and elderly people. Importantly, pulse pressure was also found to be superior to SBP or DBP as a predictor of coronary heart disease in a middle-aged and elderly Framingham population. Lastly, dual models of SBP with DBP and pulse pressure with mean arterial pressure were superior to single BP component models for predicting CVD events; thus, increases in both peripheral vascular resistance and central large artery stiffness contribute to CVD in varying proportions depending on age. Furthermore, the Framingham Heart Study provided evidence that DBP <70 mm Hg with SBP ≥120 mm Hg was associated with a CVD risk equivalent to approximately 20 mm Hg of additional elevation in SBP, thus further supporting the importance of large artery stiffness as a CVD risk factor in elderly people. These original Framingham studies have contributed greatly to BP risk classification tables for the "Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" and for the European Society for Hypertension. Moreover, Framingham originally brought attention to hypertension, which is now the leading cause of mortality globally.
这是一篇关于弗雷明汉心脏研究对我们理解血压（BP）和心血管疾病（CVD）流行病学贡献的历史回顾。弗雷明汉的研究人员最初探讨了各种血压成分与男性和女性冠心病的流行病学关系，以及年龄如何进一步改变这种风险，即舒张压（DBP）如何在年轻人中比收缩压（SBP）更能预测冠心病风险，而收缩压在中年人和老年人中更具预测性。弗雷明汉的研究人员随后在血压正常和未经治疗的高血压个体中进行了30年的随访，研究了各种血压成分的自然史，并展示了这如何为脉压作为中老年人大动脉僵硬度标志物的重要性提供血流动力学见解。重要的是，在弗雷明汉的中老年人群中，脉压作为冠心病的预测指标也优于收缩压或舒张压。最后，收缩压与舒张压以及脉压与平均动脉压的双变量模型在预测心血管疾病事件方面优于单一血压成分模型；因此，外周血管阻力和中心大动脉僵硬度的增加根据年龄以不同比例导致心血管疾病。此外，弗雷明汉心脏研究提供的证据表明，舒张压<70mmHg且收缩压≥120mmHg与心血管疾病风险相当，相当于收缩压额外升高约20mmHg，从而进一步支持了大动脉僵硬度作为老年人心血管疾病风险因素的重要性。这些最初的弗雷明汉研究对《美国预防、检测、评估和治疗高血压联合委员会第七次报告》以及欧洲高血压学会的血压风险分类表做出了巨大贡献。此外，弗雷明汉最初引起了人们对高血压的关注，而高血压现在是全球主要的死亡原因。
