2017ACC/AHA 高血压指南定义的 1 期高血压与长期心血管风险相关。

Long-Term Cardiovascular Risk Associated With Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline.

机构信息

Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China; and the Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.

出版信息

J Am Coll Cardiol. 2018 Sep 11;72(11):1201-1210. doi: 10.1016/j.jacc.2018.06.056.

DOI:10.1016/j.jacc.2018.06.056

PMID:30189996

Abstract

BACKGROUND

Systolic/diastolic blood pressure (BP) of 130 to 139/80 to 89 mm Hg has been recently defined as stage 1 hypertension by the 2017 American College of Cardiology/American Heart Association hypertension guideline. To what extent this BP stratum affects cardiovascular risk needs to be quantified in considering its adoption in China.

OBJECTIVES

The purpose of this study was to assess the relative risk and population-attributable risk of cardiovascular disease (CVD) associated with stage 1 hypertension and age-specific differences.

METHODS

In total, 21,441 participants age ≥35 years and free of CVD at baseline were followed for up to 20 years in the Chinese Multi-provincial Cohort Study. The adjusted hazard ratio (HR) and population-attributable risk for CVD associated with stage 1 hypertension were calculated.

RESULTS

Participants with stage 1 hypertension accounted for 25.8% of the cohort. Among participants age 35 to 59 years, the HR comparing stage 1 hypertension to BP <120/<80 mm Hg for CVD incidence was 1.78 (95% confidence interval [CI]: 1.50 to 2.11), coronary heart disease incidence was HR: 1.77 (95% CI: 1.33 to 2.36), stroke incidence was HR: 1.79 (95% CI: 1.45 to 2.22), and CVD mortality was HR: 2.50 (95% CI: 1.66 to 3.77). The proportions of cardiovascular deaths and events attributable to stage 1 hypertension were 26.5% and 13.4% among participants age 35 to 59 years, respectively. Among participants age ≥60 years, however, stage 1 hypertension was not related to increased risk compared with BP <120/<80 mm Hg, and population-attributable risk associated with this stratum was not found. Over a 15-year period, 65.0% of participants age 35 to 59 years with stage 1 hypertension experienced an increase in BP to 140/90 mm Hg or higher, and they had a 3.01-fold increased cardiovascular risk compared with those who maintained BP <130/<80 mm Hg.

CONCLUSIONS

The effect of 2017 American College of Cardiology/American Heart Association stage 1 hypertension on cardiovascular risk is evidenced in young and middle-aged Chinese adults, but not in those age ≥60 years.

摘要

背景

2017 年美国心脏病学会/美国心脏协会高血压指南将收缩压/舒张压为 130-139/80-89mmHg 定义为 1 期高血压。在考虑将其纳入中国时，需要量化这一血压水平对心血管风险的影响程度。

目的

本研究旨在评估与 1 期高血压相关的心血管疾病（CVD）的相对风险和人群归因风险，以及年龄特异性差异。

方法

在中国多省队列研究中，共有 21441 名年龄≥35 岁且基线时无 CVD 的参与者，随访时间长达 20 年。计算与 1 期高血压相关的 CVD 的校正风险比（HR）和人群归因风险。

结果

患有 1 期高血压的参与者占队列的 25.8%。在年龄 35-59 岁的参与者中，与 BP<120/<80mmHg 相比，1 期高血压与 CVD 发生率的 HR 为 1.78（95%置信区间[CI]：1.50 至 2.11），冠心病发生率的 HR 为 1.77（95%CI：1.33 至 2.36），卒中发生率的 HR 为 1.79（95%CI：1.45 至 2.22），CVD 死亡率的 HR 为 2.50（95%CI：1.66 至 3.77）。在年龄 35-59 岁的参与者中，心血管死亡和事件归因于 1 期高血压的比例分别为 26.5%和 13.4%。然而，在年龄≥60 岁的参与者中，与 BP<120/<80mmHg 相比，1 期高血压与增加的风险无关，也未发现该分层与人群归因风险之间存在关联。在 15 年期间，65.0%的年龄在 35-59 岁的 1 期高血压患者的血压升高至 140/90mmHg 或更高，与那些保持 BP<130/<80mmHg 的患者相比，他们的心血管风险增加了 3.01 倍。