Tajeu Gabriel S, Booth John N, Colantonio Lisandro D, Gottesman Rebecca F, Howard George, Lackland Daniel T, O'Brien Emily C, Oparil Suzanne, Ravenell Joseph, Safford Monika M, Seals Samantha R, Shimbo Daichi, Shea Steven, Spruill Tanya M, Tanner Rikki M, Muntner Paul
From Department of Health Services Administration and Policy, Temple University, Philadelphia, PA (G.S.T.); Department of Epidemiology (J.N.B., L.D.C., R.M.T., P.M.), Department of Biostatistics (G.H.), Department of Medicine, Division of Cardiovascular Disease, Vascular Biology and Hypertension Program (S.O.), Department of Medicine (M.M.S.), University of Alabama at Birmingham; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, Medical University of South Carolina, Charleston (D.T.L.); Duke Clinical Research Institute, Duke University, Durham, NC (E.C.O.); Department of Population Health, New York University School of Medicine (J.R., T.S.); Department of Medicine, Weill Cornell Medical College, New York (M.M.S.); Department of Mathematics and Statistics, University of West Florida, Pensacola, FL (S.R.S.); Department of Medicine (D.S.), Departments of Medicine and Epidemiology (S.S.), Columbia University, New York.
Circulation. 2017 Aug 29;136(9):798-812. doi: 10.1161/CIRCULATIONAHA.117.027362. Epub 2017 Jun 20.
Data from before the 2000s indicate that the majority of incident cardiovascular disease (CVD) events occur among US adults with systolic and diastolic blood pressure (SBP/DBP) ≥140/90 mm Hg. Over the past several decades, BP has declined and hypertension control has improved.
We estimated the percentage of incident CVD events that occur at SBP/DBP <140/90 mm Hg in a pooled analysis of 3 contemporary US cohorts: the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), the MESA (Multi-Ethnic Study of Atherosclerosis), and the JHS (Jackson Heart Study) (n=31 856; REGARDS=21 208; MESA=6779; JHS=3869). Baseline study visits were conducted in 2003 to 2007 for REGARDS, 2000 to 2002 for MESA, and 2000 to 2004 for JHS. BP was measured by trained staff using standardized methods. Antihypertensive medication use was self-reported. The primary outcome was incident CVD, defined by the first occurrence of fatal or nonfatal stroke, nonfatal myocardial infarction, fatal coronary heart disease, or heart failure. Events were adjudicated in each study.
Over a mean follow-up of 7.7 years, 2584 participants had incident CVD events. Overall, 63.0% (95% confidence interval [CI], 54.9-71.1) of events occurred in participants with SBP/DBP <140/90 mm Hg; 58.4% (95% CI, 47.7-69.2) and 68.1% (95% CI, 60.1-76.0) among those taking and not taking antihypertensive medication, respectively. The majority of events occurred in participants with SBP/DBP <140/90 mm Hg among those <65 years of age (66.7%; 95% CI, 60.5-73.0) and ≥65 years of age (60.3%; 95% CI, 51.0-69.5), women (61.4%; 95% CI, 49.9-72.9) and men (63.8%; 95% CI, 58.4-69.1), and for whites (68.7%; 95% CI, 66.1-71.3), blacks (59.0%; 95% CI, 49.5-68.6), Hispanics (52.7%; 95% CI, 45.1-60.4), and Chinese-Americans (58.5%; 95% CI, 45.2-71.8). Among participants taking antihypertensive medication with SBP/DBP <140/90 mm Hg, 76.6% (95% CI, 75.8-77.5) were eligible for statin treatment, but only 33.2% (95% CI, 32.1-34.3) were taking one, and 19.5% (95% CI, 18.5-20.5) met the SPRINT (Systolic Blood Pressure Intervention Trial) eligibility criteria and may benefit from a SBP target goal of 120 mm Hg.
Although higher BP levels are associated with increased CVD risk, in the modern era, the majority of incident CVD events occur in US adults with SBP/DBP <140/90 mm Hg. While absolute risk and cost-effectiveness should be considered, additional CVD risk-reduction measures for adults with SBP/DBP <140/90 mm Hg at high risk for CVD may be warranted.
21世纪前的数据表明，大多数新发心血管疾病（CVD）事件发生在美国收缩压和舒张压（SBP/DBP）≥140/90 mmHg的成年人中。在过去几十年中，血压有所下降，高血压控制情况有所改善。
我们在对3个当代美国队列进行的汇总分析中，估计了SBP/DBP<140/90 mmHg时发生的新发CVD事件的百分比：REGARDS研究（卒中地理和种族差异原因研究）、MESA（动脉粥样硬化多民族研究）和JHS（杰克逊心脏研究）（n=31856；REGARDS=21208；MESA=6779；JHS=3869）。REGARDS的基线研究访视在2003年至2007年进行，MESA在2000年至2002年进行，JHS在2000年至2004年进行。血压由经过培训的工作人员使用标准化方法测量。降压药物使用情况通过自我报告获得。主要结局是新发CVD，定义为首次发生致命或非致命性卒中、非致命性心肌梗死、致命性冠心病或心力衰竭。各研究中对事件进行了判定。
在平均随访时间为7.7年的过程中，2584名参与者发生了新发CVD事件。总体而言，63.0%（95%置信区间[CI]，54.9 - 71.1）的事件发生在SBP/DBP<140/90 mmHg的参与者中；在服用和未服用降压药物的参与者中，这一比例分别为58.4%（95%CI，47.7 - 69.2）和68.1%（95%CI，60.1 - 76.0）。在年龄<65岁（66.7%；95%CI，60.5 - 73.0）和≥65岁（60.3%；95%CI，51.0 - 69.5）的参与者中，在女性（61.4%；95%CI，49.9 - 72.9）和男性（63.8%；95%CI，58.4 - 69.1）中，以及在白人（68.7%；95%CI，66.1 - 71.3）、黑人（59.0%；95%CI，49.5 - 68.6）、西班牙裔（52.7%；95%CI，45.1 - 60.4）和华裔美国人（58.5%；95%CI，45.2 - 71.8）中，大多数事件发生在SBP/DBP<140/90 mmHg的参与者中。在SBP/DBP<140/90 mmHg且服用降压药物的参与者中，76.6%（95%CI，75.8 - 77.5）符合他汀类药物治疗条件，但只有33.2%（95%CI，32.1 - 34.3）正在服用，19.5%（95%CI，18.5 - 20.5）符合SPRINT（收缩压干预试验）纳入标准，可能从收缩压目标值120 mmHg中获益。
尽管较高的血压水平与CVD风险增加相关，但在现代，大多数新发CVD事件发生在SBP/DBP<140/90 mmHg的美国成年人中。虽然应考虑绝对风险和成本效益，但对于CVD高风险且SBP/DBP<140/90 mmHg的成年人，可能有必要采取额外的CVD风险降低措施。
