Rutan G H, Kuller L H, Neaton J D, Wentworth D N, McDonald R H, Smith W M
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261.
Circulation. 1988 Mar;77(3):504-14. doi: 10.1161/01.cir.77.3.504.
The large cohort of white men (317,871) 35 to 57 years old at initial screening for possible enrollment into the Multiple Risk Factor Intervention Trial (MRFIT) was examined with regard to initial blood pressure levels and subsequent coronary heart disease (CHD), stroke, and all-cause mortality. The overall prevalence of isolated systolic hypertension (ISH), defined as systolic blood pressure (SBP) greater than or equal to 160 mm Hg and diastolic blood pressure (DBP) less than 90 mm Hg, was 0.67% among white men screened for MRFIT and increased with age (0.31% among 35- to 39-year-olds to 1.7% among 55- to 57-year-olds). The 6 year CHD and all-cause mortality rates in men over 50 were highest in those with ISH compared with both subjects with diastolic hypertension and those with normal pressure. The relative risk of death from stroke in those with ISH, compared with that in those with SBP less than 160 mm Hg and those with DBP less than 90 mm Hg, was 3.0 (95% confidence interval 1.3 to 6.8). In addition, at any level of DBP, the level of SBP appeared to be the major determinant of all-cause and CHD mortality. The determinants of ISH in individuals under 60 years of age as well as the possible efficacy of its treatment should be evaluated further.
对一大群年龄在35至57岁、最初接受筛查以确定是否可能纳入多重危险因素干预试验（MRFIT）的白人男性（317,871人），就其初始血压水平以及随后的冠心病（CHD）、中风和全因死亡率进行了检查。孤立性收缩期高血压（ISH）的总体患病率定义为收缩压（SBP）大于或等于160毫米汞柱且舒张压（DBP）小于90毫米汞柱，在接受MRFIT筛查的白人男性中为0.67%，且随年龄增长而增加（35至39岁人群中为0.31%，55至57岁人群中为1.7%）。与舒张压高血压患者和血压正常者相比，50岁以上患有ISH的男性的6年冠心病和全因死亡率最高。与收缩压低于160毫米汞柱且舒张压低于90毫米汞柱的人相比，ISH患者中风死亡的相对风险为3.0（95%置信区间为1.3至6.8）。此外，在任何舒张压水平下，收缩压水平似乎都是全因死亡率和冠心病死亡率的主要决定因素。60岁以下个体ISH的决定因素及其治疗的可能疗效应进一步评估。
