Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of).
Department of Internal Medicine, Armed Forces Capital Hospital, Gyeonggi-do, Korea (the Republic of).
Heart. 2021 Sep;107(18):1472-1479. doi: 10.1136/heartjnl-2020-318193. Epub 2021 Jan 5.
To investigate the risk of major adverse cardiac and cerebrovascular events (MACCEs) and all-cause death of patients with controlled hypertension and suggest the benefits of physical activity in their prognosis.
People aged 40-69 years from the prospective UK Biobank cohort (UKB, n=220 026) and the retrospective Korean National Health Insurance Service cohort (KNHIS, n=3 593 202) were included in this observational cohort study, excluding those with previous cerebrocardiovascular diseases or hypertension without treatment. The study groups were stratified into normotension, controlled hypertension (patients with hypertension with systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg) and uncontrolled hypertension groups. The outcomes were MACCEs and all-cause mortality, analysed by Cox regression analysis.
We included 161 405/18 844/39 777 and 3 122 890/383 828/86 484 individuals with normotension/controlled hypertension/uncontrolled hypertension state from the UKB and KNHIS cohorts, respectively. The controlled hypertension group showed significantly higher risk of MACCEs (UKB: adjusted HR 1.73 (95% CI 1.55 to 1.92); KNHIS: 1.46 (95% CI 1.43 to 1.49)) and all-cause mortality (UKB: adjusted HR 1.28 (95% CI 1.18 to 1.39); KNHIS: 1.29 (95% CI 1.26 to 1.32)) than individuals with normotension. The controlled hypertension group not involved in any moderate or moderate-to-vigorous physical activity showed high risk of adverse outcomes, which was comparable with or even higher than the risk of patients with uncontrolled hypertension who were engaged in physical activity.
Controlled hypertension is associated with residual risks of adverse outcomes. Clinicians may encourage physical activity for patients with controlled hypertension, not being reassured by their achieved target blood pressure values.
研究血压得到控制的高血压患者发生主要不良心脑血管事件（MACCEs）和全因死亡的风险，并探讨身体活动对其预后的益处。
本观察性队列研究纳入了前瞻性英国生物银行队列（UKB，n=220026 人）和回顾性韩国国家健康保险服务队列（KNHIS，n=3593202 人）中的 40-69 岁人群，排除了既往有脑血管疾病或未经治疗的高血压患者。将研究人群分为正常血压、血压控制（高血压患者收缩压<140mmHg 且舒张压<90mmHg）和血压未控制三组。采用 Cox 回归分析评估 MACCEs 和全因死亡率等结局。
我们从 UKB 和 KNHIS 队列中分别纳入了 161405/18844/39777 名和 3122890/383828/86484 名血压正常/血压控制/血压未控制的个体。与血压正常者相比，血压控制组发生 MACCEs 的风险显著更高（UKB：校正 HR 1.73（95%CI 1.55 至 1.92）；KNHIS：1.46（95%CI 1.43 至 1.49））和全因死亡率（UKB：校正 HR 1.28（95%CI 1.18 至 1.39）；KNHIS：1.29（95%CI 1.26 至 1.32））。未参与任何中强度或中高强度身体活动的血压控制组发生不良结局的风险较高，与进行身体活动的血压未控制患者的风险相当，甚至更高。
血压得到控制与不良结局的残余风险相关。临床医生可能会鼓励血压控制患者进行身体活动，而不仅仅是依靠他们的目标血压值。
