The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan.
The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
Eur J Prev Cardiol. 2022 Oct 20;29(14):1921-1929. doi: 10.1093/eurjpc/zwac193.
Few studies have examined the relationship of blood pressure (BP) change in adults with elevated BP or stage 1 hypertension according to the American College of Cardiology (ACC)/American Heart Association (AHA) guideline with cardiovascular outcomes. We sought to identify the effect of BP change among individuals with elevated BP or stage 1 hypertension on incident heart failure (HF) and other cardiovascular diseases (CVDs).
We conducted a retrospective cohort study including 616 483 individuals (median age 46 years, 73.7% men) with elevated BP or stage 1 hypertension based on the ACC/AHA BP guideline. Participants were categorized using BP classification at one-year as normal BP (n = 173 558), elevated BP/stage 1 hypertension (n = 367 454), or stage 2 hypertension (n = 75 471). The primary outcome was HF, and the secondary outcomes included (separately) myocardial infarction (MI), angina pectoris (AP), and stroke. Over a mean follow-up of 1097 ± 908 days, 10 544 HFs, 1317 MIs, 11 070 APs, and 5198 strokes were recorded. Compared with elevated BP/stage 1 hypertension at one-year, normal BP at one-year was associated with a lower risk of developing HF [hazard ratio (HR): 0.89, 95% CI:0.85-0.94], whereas stage 2 hypertension at one-year was associated with an elevated risk of developing HF (HR:1.43, 95% CI:1.36-1.51). This association was also present in other cardiovascular outcomes including MI, AP, and stroke. The relationship was consistent in all subgroups stratified by age, sex, baseline BP category, and overweight/obesity.
A one-year decline in BP was associated with the lower risk of HF, MI, AP, and stroke, suggesting the importance of lowering BP in individuals with elevated BP or stage 1 hypertension according to the ACC/AHA guideline to prevent the risk of developing CVD.
根据美国心脏病学会（ACC）/美国心脏协会（AHA）指南，很少有研究检查成年人血压（BP）变化与心血管结局之间的关系，这些成年人的血压升高或 1 期高血压。我们试图确定血压升高或 1 期高血压患者的 BP 变化对心力衰竭（HF）和其他心血管疾病（CVD）事件的影响。
我们进行了一项回顾性队列研究，纳入了根据 ACC/AHA BP 指南，BP 升高或 1 期高血压的 616483 名患者（中位年龄 46 岁，73.7%为男性）。根据一年时的 BP 分类，患者分为正常 BP（n=173558）、BP 升高/1 期高血压（n=367454）或 2 期高血压（n=75471）。主要结局是 HF，次要结局包括（分别）心肌梗死（MI）、心绞痛（AP）和中风。平均随访 1097±908 天后，记录到 10544 例 HF、1317 例 MI、11070 例 AP 和 5198 例中风。与一年时的 BP 升高/1 期高血压相比，一年时的正常 BP 与 HF 发生风险降低相关[风险比（HR）：0.89，95%置信区间（CI）：0.85-0.94]，而一年时的 2 期高血压与 HF 发生风险升高相关（HR：1.43，95% CI：1.36-1.51）。这一关联在 MI、AP 和中风等其他心血管结局中也存在。该关联在按年龄、性别、基线 BP 类别和超重/肥胖分层的所有亚组中均一致。
BP 下降一年与 HF、MI、AP 和中风风险降低相关，这表明根据 ACC/AHA 指南，在血压升高或 1 期高血压患者中降低血压对于预防 CVD 风险非常重要。
