From the Department of Clinical Science and Education (P.O., P.S.), Karolinska Institutet, Stockholm, Sweden.
Institute for Environmental Medicine (H.H.), Karolinska Institutet, Stockholm, Sweden.
Hypertension. 2020 Jan;75(1):229-236. doi: 10.1161/HYPERTENSIONAHA.119.14002. Epub 2019 Dec 2.
In the emergency department (ED), high blood pressure (BP) is commonly observed but mostly used to evaluate patients' health in the short term. We aimed to study whether ED-measured BP is associated with incident atherosclerotic cardiovascular disease (ASCVD), myocardial infarction, or stroke in long term, and to estimate the number needed to screen to prevent ASCVD. In this cohort study, participants were selected from a university hospital between 2010 and 2016, with an obtained BP in the ED. The outcome information was acquired through the Swedish National Patient Register for all participants. The association was estimated with Cox-regression. Among the included 300 193 subjects, 8999 incident ASCVD events occurred during a median follow-up for 3.5 years. Both DBP and systolic blood pressure were associated with incident ASCVD, myocardial infarction, and stroke with a progressively increased risk for systolic blood pressure within hypertension grade 1 (HR, 1.15 [95% CI, 1.06-1.24]), 2 (HR, 1.35 [95% CI, 1.25-1.47]), and 3 (HR, 1.63 [95% CI, 1.49-1.77]). The 6-year cumulative incidence of ASCVD was 12% for systolic blood pressure ≥180 mm Hg compared with 2% for normal levels. To prevent one ASCVD event during the median follow-up, the number needed to screen was estimated to 151, whereas the number needed to treat to 71. ED-recorded BP is associated with incident ASCVD, myocardial infarction, and stroke. High-BP recordings in EDs should not be disregarded but an opportunity to detect and improve the treatment of hypertension. ED-measured BP provides an important and underused tool with great potential to reduce morbidity and mortality associated with hypertension. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT03954119.
在急诊部门（ED），高血压（BP）很常见，但主要用于评估患者的短期健康状况。我们旨在研究 ED 测量的 BP 是否与长期的动脉粥样硬化性心血管疾病（ASCVD）、心肌梗死或中风事件有关，并估计筛查以预防 ASCVD 的人数。在这项队列研究中，参与者是在 2010 年至 2016 年期间从一所大学医院中选择的，在 ED 中获得了 BP。所有参与者的结果信息都是通过瑞典国家患者登记处获得的。使用 Cox 回归估计相关性。在包括的 300193 名受试者中，中位随访 3.5 年后发生了 8999 例 ASCVD 事件。DBP 和收缩压均与 ASCVD、心肌梗死和中风事件相关，随着高血压 1 级（HR，1.15 [95%CI，1.06-1.24]）、2 级（HR，1.35 [95%CI，1.25-1.47]）和 3 级（HR，1.63 [95%CI，1.49-1.77]）的收缩压升高，风险逐渐增加。与正常水平相比，收缩压≥180mmHg 的患者在 6 年内 ASCVD 的累积发生率为 12%，而正常水平的患者为 2%。为了在中位随访期间预防一次 ASCVD 事件，估计需要筛查的人数为 151 人，而需要治疗的人数为 71 人。ED 记录的 BP 与 ASCVD、心肌梗死和中风事件相关。ED 中记录的高血压不应被忽视，而是有机会发现并改善高血压的治疗。ED 测量的 BP 提供了一个重要的、未充分利用的工具，具有很大的潜力可以降低与高血压相关的发病率和死亡率。临床试验注册- URL：http://www.clinicaltrials.gov。唯一标识符：NCT03954119。
