Framingham Heart Study, Framingham.
Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Hypertens. 2018 Feb;36(2):436-443. doi: 10.1097/HJH.0000000000001570.
We evaluated the incidence of cardiovascular disease (CVD) in individuals whose blood pressure (BP) management strategy would change with adoption of recent US hypertension guidelines in two large, community-based cohorts with different racial and geographic compositions: the Framingham and Jackson Heart Studies (FHS and JHS).
We assigned 11 237 FHS (mean age 46, 53% women) and 2948 JHS (mean age 55, 69% women) participants free of CVD and chronic kidney disease to one of five categories representing different treatment recommendations between 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee and The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines. Absolute incidence rates (incidence rate; per 1000 person-years) and multivariable-adjusted hazard ratios were calculated for each group; cohort-specific results were combined using fixed effect meta-analysis.
CVD events occurred in 1047 FHS and 230 JHS participants during mean follow-up times of 11 and 8.9 years, respectively. Compared with individuals without hypertension, those with BP 140-149/<90 mmHg had increased risk for CVD regardless of treatment status [hazard ratio for untreated BP 140-149/<90 mmHg 1.96, 95% confidence interval (CI) 1.40-2.75; hazard ratio for treated BP 140-149/<90 mmHg 3.37, 95% CI 2.37-4.78]. The risk for those with treated BP 140-149/<90 mmHg was consistent in those aged at least 60 years (hazard ratio: 2.61, 95% CI 1.75-3.90). Statistical power was limited to evaluate the effect of diabetes.
Individuals with treated BP 140-149/<90 mmHg have increased risk of CVD compared with those without hypertension including in participants at least 60 years. The 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee recommendations to treat BP levels less aggressively may be associated with substantial residual CVD risk.
我们评估了在两个具有不同种族和地理组成的大型社区队列（弗雷明汉心脏研究和杰克逊心脏研究）中，随着美国高血压指南的更新，血压管理策略将发生变化的个体患心血管疾病（CVD）的发生率。
我们将 11237 名弗雷明汉心脏研究（平均年龄 46 岁，53%为女性）和 2948 名杰克逊心脏研究（平均年龄 55 岁，69%为女性）参与者分配到五个类别中，这些参与者无 CVD 和慢性肾病，并代表 2014 年成人高血压管理循证指南：第八届联合国家委员会成员报告和第七次联合国家委员会预防、检测、评估和治疗高血压指南之间的不同治疗建议。根据每个组别的不同，计算绝对发病率（发病率；每 1000 人年）和多变量调整后的风险比；使用固定效应荟萃分析合并队列特异性结果。
在平均随访时间分别为 11 年和 8.9 年的时间内，1047 名弗雷明汉心脏研究和 230 名杰克逊心脏研究参与者中发生了 1047 例 CVD 事件。与无高血压的个体相比，无论治疗状态如何，BP140-149/<90mmHg 的个体 CVD 风险增加[未治疗 BP140-149/<90mmHg 的风险比为 1.96，95%置信区间（CI）为 1.40-2.75；治疗 BP140-149/<90mmHg 的风险比为 3.37，95%CI 为 2.37-4.78]。对于年龄至少 60 岁的个体，治疗后 BP140-149/<90mmHg 的个体的风险是一致的（风险比：2.61，95%CI 为 1.75-3.90）。评估糖尿病影响的统计能力有限。
与无高血压的个体相比，治疗后的 BP140-149/<90mmHg 的个体发生 CVD 的风险增加，包括年龄至少 60 岁的个体。2014 年成人高血压管理循证指南：第八届联合国家委员会成员报告建议更积极地治疗血压水平可能与大量残余 CVD 风险相关。
