Center of Endocrinology, National Center of Cardiology & Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Da Qing First Hospital, Daqing, China.
Diabetes Obes Metab. 2024 Mar;26(3):871-877. doi: 10.1111/dom.15379. Epub 2023 Nov 27.
Whether systolic/diastolic blood pressure (SBP/DBP) values of 130-139/80-89 mmHg should be defined as hypertension has been debated for decades. We aimed to characterize the effect of high-normal BP on cardiovascular disease (CVD) events and deaths.
In total, 1726 individuals from the original Da Qing IGT and Diabetes Study were enrolled, and divided into the normal BP group (SBP <130 mmHg and DBP <80 mmHg), high-normal BP group (SBP 130-139 mmHg and/or DBP 80-89 mmHg) and hypertension group (SBP ≥140 mmHg and/or DBP ≥90 mmHg). CVD events and their components were assessed from 1986 to 2016.
During the 30-year follow-up, the high-normal BP group was not at higher risk for CVD events [hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.84-1.30, p = .68], coronary heart disease (HR 1.12, 95% CI 0.77-1.63, p = .57), stroke (HR 1.05, 95% CI 0.82-1.34, p = .71), or CVD deaths (HR 1.15, 95% CI 0.82-1.60, p = .41) compared with the normal BP group, after adjusting for covariates. However, the hypertension group exhibited significantly increased cardiovascular risk (CVD events, HR 1.91, 95% CI 1.48-2.46, p < .0001; coronary heart disease, HR 1.73, 95% CI 1.12-2.67, p = .01; stroke, HR 1.90, 95% CI 1.43-2.52, p < .0001; CVD deaths, HR 2.07, 95% CI 1.43-3.01, p = .0001) than the normal BP group. Subgroup analyses showed that, regardless of the presence of diabetes, high-normal BP did not increase CVD events compared with normal BP.
This post-hoc study provided no evidence that the high-normal BP increased cardiovascular risk in the Da Qing study population, suggesting that it was reasonable to continue to define hypertension at 140/90 mmHg in China.
收缩压/舒张压（SBP/DBP）在 130-139/80-89mmHg 之间是否应定义为高血压，这一问题已经争论了几十年。本研究旨在探讨高正常血压对心血管疾病（CVD）事件和死亡的影响。
本研究共纳入了 1726 名来自大庆糖耐量异常和糖尿病研究的原始参与者，将其分为正常血压组（SBP<130mmHg 和 DBP<80mmHg）、高正常血压组（SBP 130-139mmHg 和/或 DBP 80-89mmHg）和高血压组（SBP≥140mmHg 和/或 DBP≥90mmHg）。从 1986 年到 2016 年，评估了 CVD 事件及其组成部分。
在 30 年的随访期间，高正常血压组发生 CVD 事件的风险并不高于正常血压组[风险比（HR）1.05，95%置信区间（CI）0.84-1.30，p=0.68]、冠心病（HR 1.12，95%CI 0.77-1.63，p=0.57）、卒中等（HR 1.05，95%CI 0.82-1.34，p=0.71）或 CVD 死亡（HR 1.15，95%CI 0.82-1.60，p=0.41），校正协变量后。然而，与正常血压组相比，高血压组的心血管风险显著增加（CVD 事件，HR 1.91，95%CI 1.48-2.46，p<0.0001；冠心病，HR 1.73，95%CI 1.12-2.67，p=0.01；卒中等，HR 1.90，95%CI 1.43-2.52，p<0.0001；CVD 死亡，HR 2.07，95%CI 1.43-3.01，p=0.0001）。亚组分析表明，无论是否存在糖尿病，高正常血压与正常血压相比均不会增加 CVD 事件。
本事后分析结果未提供高正常血压会增加大庆研究人群心血管风险的证据，提示在中国继续将 140/90mmHg 定义为高血压是合理的。
