From the Division of Research, Kaiser Permanente Northern California, Oakland (A.C.F., C.C.), and the Departments of Neuroscience (A.C.F., S.L.C., V.A.R., R.B.M.) and Cardiology (X.R., N.M.B.), Kaiser Permanente, Redwood City - both in California; and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School - both in Boston (D.L.B.).
N Engl J Med. 2019 Jul 18;381(3):243-251. doi: 10.1056/NEJMoa1803180.
The relationship between outpatient systolic and diastolic blood pressure and cardiovascular outcomes remains unclear and has been complicated by recently revised guidelines with two different thresholds (≥140/90 mm Hg and ≥130/80 mm Hg) for treating hypertension.
Using data from 1.3 million adults in a general outpatient population, we performed a multivariable Cox survival analysis to determine the effect of the burden of systolic and diastolic hypertension on a composite outcome of myocardial infarction, ischemic stroke, or hemorrhagic stroke over a period of 8 years. The analysis controlled for demographic characteristics and coexisting conditions.
The burdens of systolic and diastolic hypertension each independently predicted adverse outcomes. In survival models, a continuous burden of systolic hypertension (≥140 mm Hg; hazard ratio per unit increase in z score, 1.18; 95% confidence interval [CI], 1.17 to 1.18) and diastolic hypertension (≥90 mm Hg; hazard ratio per unit increase in z score, 1.06; 95% CI, 1.06 to 1.07) independently predicted the composite outcome. Similar results were observed with the lower threshold of hypertension (≥130/80 mm Hg) and with systolic and diastolic blood pressures used as predictors without hypertension thresholds. A J-curve relation between diastolic blood pressure and outcomes was seen that was explained at least in part by age and other covariates and by a higher effect of systolic hypertension among persons in the lowest quartile of diastolic blood pressure.
Although systolic blood-pressure elevation had a greater effect on outcomes, both systolic and diastolic hypertension independently influenced the risk of adverse cardiovascular events, regardless of the definition of hypertension (≥140/90 mm Hg or ≥130/80 mm Hg). (Funded by the Kaiser Permanente Northern California Community Benefit Program.).
门诊收缩压和舒张压与心血管结局之间的关系尚不清楚，最近修订的指南将高血压的治疗阈值分为两个不同的标准（≥140/90mmHg 和≥130/80mmHg），使情况变得更加复杂。
我们利用一般门诊人群中 130 万成年人的数据，进行了多变量 Cox 生存分析，以确定收缩压和舒张压高血压负担对 8 年内心肌梗死、缺血性卒中和出血性卒中复合结局的影响。该分析控制了人口统计学特征和并存疾病。
收缩压和舒张压高血压负担各自独立预测不良结局。在生存模型中，收缩压高血压（≥140mmHg；每单位 z 评分增加的风险比，1.18；95%置信区间[CI]，1.17 至 1.18）和舒张压高血压（≥90mmHg；每单位 z 评分增加的风险比，1.06；95%CI，1.06 至 1.07）的负担独立预测了复合结局。在高血压的较低阈值（≥130/80mmHg）和使用无高血压阈值的收缩压和舒张压作为预测因子时，也观察到了类似的结果。舒张压与结局之间存在 J 形关系，该关系至少部分由年龄和其他协变量以及最低舒张压四分位数人群中收缩压高血压的更高影响来解释。
尽管收缩压升高对结局的影响更大，但收缩压和舒张压高血压均独立影响不良心血管事件的风险，无论高血压的定义（≥140/90mmHg 或≥130/80mmHg）如何。（由 Kaiser Permanente Northern California 社区福利计划资助）。
