Internal Medicine Residency Program Boston University School of Medicine Boston MA.
Department of Epidemiology Boston University School of Public Health Boston MA.
J Am Heart Assoc. 2022 Mar 15;11(6):e024202. doi: 10.1161/JAHA.121.024202. Epub 2022 Mar 9.
Background The epidemiology of hypertension subtypes has not been well characterized in the recent era. Methods and Results We delineated the prevalence, predictors, progression, and prognostic significance of hypertension subtypes in 8198 Framingham Heart Study participants (mean age, 46.5 years; 54% women). The prevalence of hypertension subtypes was as follows: nonhypertensive (systolic blood pressure [SBP] <140 mm Hg and diastolic blood pressure [DBP] <90 mm Hg), 79%; isolated systolic hypertension (ISH; SBP ≥140 mm Hg and DBP <90 mm Hg), 8%; isolated diastolic hypertension (SBP <140 mm Hg and DBP ≥90 mm Hg), 4%; and systolic-diastolic hypertension (SDH; SBP ≥140 mm Hg and DBP ≥90 mm Hg), 9%. The prevalence of ISH and SDH increased with age. Analysis of a subsample of nonhypertensive participants demonstrated that increasing age, female sex, higher heart rate, left ventricular mass, and greater left ventricular concentricity were predictors of incident ISH and SDH. Higher baseline DBP was associated with the risk of developing isolated diastolic hypertension and SDH, whereas higher SBP was associated with all 3 hypertension subtypes. On follow-up (median, 5.5 years), isolated diastolic hypertension often reverted to nonhypertensive BP (in 42% of participants) and ISH progressed to SDH (in 26% of participants), whereas SDH frequently transitioned to ISH (in 20% of participants). During follow-up (median, 14.6 years), 889 participants developed cardiovascular disease. Compared with the nonhypertensive group (referent), ISH (adjusted hazard ratio [HR], 1.57; 95% CI, 1.30-1.90) and SDH (HR, 1.66; 95% CI, 1.36-2.01) were associated with increased cardiovascular disease risk, whereas isolated diastolic hypertension was not (HR, 1.03; 95% CI, 0.68-1.57). Conclusions Hypertension subtypes vary in prevalence with age, are dynamic during short-term follow-up, and exhibit distinctive prognoses, underscoring the importance of blood pressure subphenotyping.
背景 高血压亚型的流行病学在最近的时代尚未得到充分描述。
方法和结果 我们在 8198 名弗雷明汉心脏研究参与者（平均年龄 46.5 岁；54%为女性）中描绘了高血压亚型的患病率、预测因素、进展和预后意义。高血压亚型的患病率如下：非高血压（收缩压[SBP] <140 mmHg 和舒张压[DBP] <90 mmHg），79%；单纯收缩期高血压（ISH；SBP ≥140 mmHg 和 DBP <90 mmHg），8%；单纯舒张期高血压（SBP <140 mmHg 和 DBP ≥90 mmHg），4%；收缩-舒张期高血压（SDH；SBP ≥140 mmHg 和 DBP ≥90 mmHg），9%。ISH 和 SDH 的患病率随年龄增长而增加。对非高血压参与者的亚组分析表明，年龄增长、女性、较高的心率、左心室质量和更大的左心室向心性增加是发生 ISH 和 SDH 的预测因素。较高的基线 DBP 与发生单纯舒张期高血压和 SDH 的风险相关，而较高的 SBP 与所有 3 种高血压亚型相关。在随访期间（中位数 5.5 年），单纯舒张期高血压通常恢复为非高血压血压（在 42%的参与者中），ISH 进展为 SDH（在 26%的参与者中），而 SDH 常转为 ISH（在 20%的参与者中）。在随访期间（中位数 14.6 年），889 名参与者发生心血管疾病。与非高血压组（参照组）相比，ISH（调整后的危险比[HR]，1.57；95%CI，1.30-1.90）和 SDH（HR，1.66；95%CI，1.36-2.01）与心血管疾病风险增加相关，而单纯舒张期高血压则不然（HR，1.03；95%CI，0.68-1.57）。
结论 高血压亚型的患病率随年龄而变化，在短期随访期间具有动态性，并表现出不同的预后，突出了血压亚表型的重要性。
