Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China.
Circ Cardiovasc Qual Outcomes. 2022 Sep;15(9):e008774. doi: 10.1161/CIRCOUTCOMES.121.008774. Epub 2022 Sep 6.
Many studies demonstrate a J-shaped association between blood pressure and cardiovascular diseases (CVDs), but the findings are plagued by confounding from other traditional cardiovascular risk factors (CVRFs). Our aims were to examine the associations of systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels with CVD in individuals without major CVRFs and whether there were thresholds for the association.
In the 4C study (China Cardiometabolic Disease and Cancer Cohort), 36 042 CVRF-free participants without CVD, diabetes, dyslipidemia, hypertension, or smoking were identified during 2011 to 2012. Among CVRF-free participants, 17 476 CVRF-preferable individuals with better glycemic (fasting glucose, <110 mg/dL; 2-hour post-load glucose, <140 mg/dL) and lipid profile (total cholesterol, <200 mg/dL; LDL [low-density lipoprotein] cholesterol, <130 mg/dL) were selected. The total person-years of follow-up for CVRF-free subjects and CVRF-preferable subjects were 130 147 and 63 573 person-years, respectively. Information on the development of major CVDs was collected during 2014 to 2016. Cox proportional hazard models were performed to estimate the risks for incident CVD by SBP and DBP groups, respectively.
We found that both baseline SBP and DBP presented significantly linear associations with CVD risks in CVRF-free and CVRF-preferable participants. There is significant increase in the CVD risk among CVRF-free participants with baseline SBP level of 110 to 119 mm Hg (hazard ratio, 1.79 [95% CI, 1.19-2.71]), 120 to 129 mm Hg (hazard ratio, 2.03 [95% CI, 1.36-3.03]), and 130 to 139 mm Hg (hazard ratio, 2.15 [95% CI, 1.40-3.28]) compared with SBP <110 mm Hg. Significant increases were also observed for DBP level of 80 to 89 mm Hg (hazard ratio, 1.43 [95% CI, 1.03-1.97]) compared with DBP <70 mm Hg. Similar results were observed in CVRF-preferable participants.
SBP and DBP with levels currently considered normal were significantly and linearly associated with incident CVD without thresholds above 110/70 mm Hg among Chinese adults without major CVRFs.
许多研究表明血压与心血管疾病（CVDs）之间存在 J 形关联，但这些发现受到其他传统心血管危险因素（CVRFs）的混杂影响。我们的目的是检查无主要 CVRFs 的个体中收缩压（SBP）和舒张压（DBP）水平与 CVD 的关联，以及是否存在关联的阈值。
在 4C 研究（中国心血管疾病和癌症队列研究）中，在 2011 年至 2012 年期间确定了 36042 名无 CVD、糖尿病、血脂异常、高血压或吸烟的 CVRF 无个体。在无 CVRF 的个体中，选择了 17476 名 CVRF 优选个体，其血糖水平更好（空腹血糖<110mg/dL；负荷后 2 小时血糖<140mg/dL），血脂谱更好（总胆固醇<200mg/dL；低密度脂蛋白胆固醇<130mg/dL）。无 CVRF 受试者和 CVRF 优选受试者的总随访人年分别为 130147 人和 63573 人。在 2014 年至 2016 年期间收集了主要 CVD 发展的信息。使用 Cox 比例风险模型分别估计 SBP 和 DBP 组的 CVD 发病风险。
我们发现，在无 CVRF 和 CVRF 优选参与者中，基线 SBP 和 DBP 均与 CVD 风险呈显著线性关联。与 SBP<110mmHg 的参与者相比，基线 SBP 水平为 110-119mmHg（风险比，1.79[95%CI，1.19-2.71]）、120-129mmHg（风险比，2.03[95%CI，1.36-3.03]）和 130-139mmHg（风险比，2.15[95%CI，1.40-3.28]）的参与者发生 CVD 的风险显著增加。与 DBP<70mmHg 的参与者相比，DBP 水平为 80-89mmHg（风险比，1.43[95%CI，1.03-1.97]）的参与者也观察到显著增加。在 CVRF 优选参与者中也观察到了类似的结果。
在中国无主要 CVRFs 的成年人中，目前被认为正常的 SBP 和 DBP 水平与无阈值的 CVD 发生显著且呈线性相关，超过 110/70mmHg。
