Departments of Preventive Medicine (H.L., H.C.K.), Yonsei University College of Medicine, Seoul, Korea.
Internal Medicine (H.L., S.P., H.C.K.), Yonsei University College of Medicine, Seoul, Korea.
Circulation. 2020 Jun 2;141(22):1778-1786. doi: 10.1161/CIRCULATIONAHA.119.044838. Epub 2020 Jun 1.
Little is known regarding health outcomes associated with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), or systolic and diastolic hypertension (SDH) among young adults with stage 1 hypertension, defined using the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guideline.
From a nationwide health screening database, we included 6 424 090 participants, aged 20 to 39 years, who were not taking antihypertensive medication at the baseline examination in 2003 to 2007. Participants were categorized as having normal BP (untreated systolic BP [SBP] <120/diastolic BP [DBP] <80 mm Hg; n=2 665 310); elevated BP (SBP 120-129/DBP <80 mm Hg; n=705 344); stage 1 IDH (SBP <130/DBP 80-89 mm Hg; n=1 271 505); stage 1 ISH (SBP 130-139/DBP <80 mm Hg; n=255 588); stage 1 SDH (SBP 130-139/DBP 80-89 mm Hg; n=711 503); and stage 2 hypertension (SBP ≥140, DBP ≥90 mm Hg; n=814 840). The primary outcome was composite cardiovascular disease (CVD) events, including myocardial infarction, stroke, heart failure, and CVD-related death.
The median age of the participants was 30 years and 60.9% were male. Over a median follow-up of 13.2 years, 44 070 new CVD events occurred. With normal BP as the reference, multivariable-adjusted hazard ratios (95% CIs) for CVD events were 1.14 (1.09-1.18) for elevated BP, 1.32 (1.28-1.36) for stage 1 IDH, 1.36 (1.29-1.43) for stage 1 ISH, 1.67 (1.61-1.72) for stage 1 SDH, and 2.40 (2.33-2.47) for stage 2 hypertension.
Among young adults, stage 1 ISH, IDH, and SDH were all associated with higher CVD risks than normal BP. The CVD risks of stage 1 ISH and IDH were similar to each other but lower than the risk of stage 1 SDH. Categorizing young adults with stage 1 hypertension further into stage 1 ISH, IDH, and SDH may improve risk stratification for identifying high-risk individuals.
在使用 2017 年美国心脏病学会/美国心脏协会血压（BP）指南定义的 1 期高血压的年轻成年人中，对于单纯收缩期高血压（ISH）、单纯舒张期高血压（IDH）或收缩压和舒张压高血压（SDH）与健康结果的关系知之甚少。
我们从全国性健康筛查数据库中纳入了 6424090 名年龄在 20 至 39 岁之间的参与者，他们在 2003 年至 2007 年的基线检查时未服用抗高血压药物。参与者分为正常血压（未经治疗的收缩压[SBP] <120/舒张压[DBP] <80mmHg；n=2665310）；高血压前期（SBP 120-129/DBP <80mmHg；n=705344）；1 期 IDH（SBP <130/DBP 80-89mmHg；n=1271505）；1 期 ISH（SBP 130-139/DBP <80mmHg；n=255588）；1 期 SDH（SBP 130-139/DBP 80-89mmHg；n=711503）和 2 期高血压（SBP≥140，DBP≥90mmHg；n=814840）。主要结局是复合心血管疾病（CVD）事件，包括心肌梗死、中风、心力衰竭和与 CVD 相关的死亡。
参与者的中位年龄为 30 岁，60.9%为男性。在中位随访 13.2 年后，发生了 44070 例新的 CVD 事件。以正常血压为参照，CVD 事件的多变量校正风险比（95%CI）分别为：高血压前期为 1.14（1.09-1.18），1 期 IDH 为 1.32（1.28-1.36），1 期 ISH 为 1.36（1.29-1.43），1 期 SDH 为 1.67（1.61-1.72），2 期高血压为 2.40（2.33-2.47）。
在年轻成年人中，1 期 ISH、IDH 和 SDH 与较高的 CVD 风险均相关，高于正常血压。1 期 ISH 和 IDH 的 CVD 风险相似，但低于 1 期 SDH 的风险。将 1 期高血压的年轻成年人进一步分为 1 期 ISH、IDH 和 SDH 可能会改善风险分层，以确定高危人群。
