Columbia Hypertension Laboratory, Department of Medicine, Columbia University Irving Medical Center, New York, NY (E.C., D.S.).
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL (L.C., K.F., L.G., S.T.H., P.M.).
Hypertension. 2024 May;81(5):1055-1064. doi: 10.1161/HYPERTENSIONAHA.123.22220. Epub 2024 Feb 23.
Death certificate data indicate that hypertension may have increased as a contributing cause of death among US adults. Hypertension is not commonly recorded on death certificates although it contributes to a substantial proportion of cardiovascular disease (CVD) deaths.
We estimated changes in all-cause, CVD, and non-CVD mortality over 5 years of follow-up among 4 cohorts of US adults with hypertension using mortality follow-up data from National Health and Nutrition Examination Survey III in 1988 to 1994, and National Health and Nutrition Examination Survey cycles from 1999 to 2000 through 2015 to 2016 (n=20 927). Hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or antihypertensive medication use. Participants were grouped according to the date of their National Health and Nutrition Examination Survey study visit (1988-1994, 1999-2004, 2005-2010, 2011-2016).
There were 2646, 1048, and 1598 all-cause, CVD, and non-CVD deaths, respectively. After age, gender, and race/ethnicity adjustment and compared with the 1988 to 1994 cohort, the hazard ratio of all-cause mortality was 0.88 (95% CI, 0.76-1.01) for the 1999 to 2004 cohort, 0.82 (95% CI, 0.70-0.95) for the 2005 to 2010 cohort, and 0.89 (95% CI, 0.75-1.05) for the 2011 to 2016 cohort ( trend=0.123). The age, gender, and race/ethnicity-adjusted hazard ratios for CVD mortality compared with the 1988 to 1994 cohort were 0.74 (95% CI, 0.60-0.90) for the 1999 to 2004 cohort, 0.61 (95% CI, 0.50-0.74) for the 2005 to 2010 cohort, and 0.57 (95% CI, 0.44-0.74) for the 2011 to 2016 cohort ( trend <0.001). There was no evidence of a change in CVD mortality between the 2005 to 2010 and 2011 to 2016 cohorts (=0.661). Noncardiovascular mortality did not decline over the study period ( trend=0.145).
The decline in CVD mortality among US adults with hypertension stalled after 2005 to 2010.
死亡证明数据表明，美国成年人的高血压可能已成为死亡的一个主要原因。尽管高血压是心血管疾病（CVD）死亡的主要原因之一，但在死亡证明中通常并未记录。
我们使用美国国立卫生和营养调查 III 中 1988 年至 1994 年的死亡率随访数据以及 1999 年至 2000 年至 2015 年至 2016 年的国家健康和营养调查周期的数据，对患有高血压的 4 组美国成年人进行了为期 5 年的随访，以评估全因、CVD 和非 CVD 死亡率的变化（n=20927）。高血压定义为收缩压≥140mmHg、舒张压≥90mmHg 或使用降压药物。参与者根据其参加国家健康和营养调查研究的日期进行分组（1988-1994 年、1999-2004 年、2005-2010 年、2011-2016 年）。
分别有 2646、1048 和 1598 例全因、CVD 和非 CVD 死亡。在调整年龄、性别和种族/民族后，与 1988-1994 年队列相比，全因死亡率的危险比为 0.88（95%CI，0.76-1.01）对于 1999-2004 年队列，0.82（95%CI，0.70-0.95）对于 2005-2010 年队列，以及 0.89（95%CI，0.75-1.05）对于 2011-2016 年队列（趋势=0.123）。与 1988-1994 年队列相比，经年龄、性别和种族/民族调整后的 CVD 死亡率危险比为 0.74（95%CI，0.60-0.90）对于 1999-2004 年队列，0.61（95%CI，0.50-0.74）对于 2005-2010 年队列，以及 0.57（95%CI，0.44-0.74）对于 2011-2016 年队列（趋势<0.001）。在 2005-2010 年和 2011-2016 年队列之间没有证据表明 CVD 死亡率发生变化（=0.661）。在研究期间，非心血管死亡率并未下降（趋势=0.145）。
美国成年人高血压患者的 CVD 死亡率下降在 2005 年至 2010 年后趋于停滞。
