Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China.
Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China.
PLoS One. 2021 Jul 30;16(7):e0255373. doi: 10.1371/journal.pone.0255373. eCollection 2021.
Blood pressure (BP) categories are useful to simplify preventions in public health, and diagnostic and treatment approaches in clinical practice. Updated evidence about the associations of BP categories with cardiovascular diseases (CVDs) and its subtypes is warranted.
About 0.5 million adults aged 30 to 79 years were recruited from 10 areas in China during 2004-2008. The present study included 430 977 participants without antihypertension treatment, cancer, or CVD at baseline. BP was measured at least twice in a single visit at baseline and CVD deaths during follow-up were collected via registries and the national health insurance databases. Multivariable Cox regression was used to estimate the associations between BP categories and CVD mortality. Overall, 16.3% had prehypertension-low, 25.1% had prehypertension-high, 14.1% had isolated systolic hypertension (ISH), 1.9% had isolated diastolic hypertension (IDH), and 9.1% had systolic-diastolic hypertension (SDH). During a median 10-year follow-up, 9660 CVD deaths were documented. Compared with normal, the hazard ratios (95% CI) of prehypertension-low, prehypertension-high, ISH, IDH, SDH for CVD were 1.10 (1.01-1.19), 1.32 (1.23-1.42), 2.04 (1.91-2.19), 2.20 (1.85-2.61), and 3.81 (3.54-4.09), respectively. All hypertension subtypes were related to the increased risk of CVD subtypes, with a stronger association for hemorrhagic stroke than for ischemic heart disease. The associations were stronger in younger than older adults.
Prehypertension-high should be considered in CVD primary prevention given its high prevalence and increased CVD risk. All hypertension subtypes were independently associated with CVD and its subtypes mortality, though the strength of associations varied substantially.
血压（BP）分类有助于简化公共卫生中的预防措施，以及临床实践中的诊断和治疗方法。需要更新有关 BP 分类与心血管疾病（CVD）及其亚型之间关联的证据。
本研究共纳入了来自中国 10 个地区的约 50 万名 30 至 79 岁的成年人。本研究共纳入了 430977 名无抗高血压治疗、癌症或 CVD 基线的参与者。BP 在基线时的单次就诊中至少测量了两次，随访期间通过登记处和国家健康保险数据库收集 CVD 死亡事件。多变量 Cox 回归用于评估 BP 分类与 CVD 死亡率之间的关联。总体而言，16.3%的参与者患有前期低血压-低，25.1%的参与者患有前期高血压-高，14.1%的参与者患有孤立性收缩期高血压（ISH），1.9%的参与者患有单纯舒张期高血压（IDH），9.1%的参与者患有收缩-舒张期高血压（SDH）。在中位 10 年的随访期间，共记录了 9660 例 CVD 死亡事件。与正常血压相比，前期低血压-低、前期高血压-高、ISH、IDH 和 SDH 与 CVD 的危险比（95%CI）分别为 1.10（1.01-1.19）、1.32（1.23-1.42）、2.04（1.91-2.19）、2.20（1.85-2.61）和 3.81（3.54-4.09）。所有高血压亚型与 CVD 亚型的风险增加有关，其中出血性卒中的相关性强于缺血性心脏病。在较年轻的成年人中，相关性更强。
鉴于前期高血压-高的高患病率和增加的 CVD 风险，应将其纳入 CVD 的一级预防。所有高血压亚型均与 CVD 及其亚型的死亡率独立相关，尽管关联的强度有很大差异。
