Tang Kevin S, Jones Jeffrey E, Fan Wenjun, Wong Nathan D
Heart Disease Prevention Program, Mary and Steve Wen Cardiovascular Division, Department of Medicine, University of California, Irvine, CA, USA.
Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA.
Am J Hypertens. 2025 Apr 15;38(5):303-312. doi: 10.1093/ajh/hpaf010.
Hypertension (HTN) has been demonstrated as one of the leading risk factors for development of cardiovascular disease (CVD) and CVD mortality.
This study examines the prevalence and distribution of HTN subtypes (isolated diastolic hypertension [IDH], isolated systolic hypertension [ISH], and systolic-diastolic hypertension [SDH]) across age, sex, and race/ethnicity per the nationally representative National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020 based on the updated 2017 ACC/AHA HTN definition. We further examined for associations of each subtype with CVD and all-cause mortality using Cox regression analysis.
Among US adults, the overall prevalence of HTN is 47.4%. Across increasing age, the prevalence of IDH decreased, ISH increased, and SDH increased and peaked in the 6th decade of life after which SDH prevalence decreased. By age 80, over 80% of persons with HTN demonstrated ISH. A subcohort from NHANES 1999-2008 with follow-up until 2018 showed that ISH and SDH were most strongly associated with increased risk for CVD (HR = 1.18, 95% CI, 1.01-1.38; HR = 1.31, 95% CI, 1.07-1.60, respectively) and all-cause mortality (HR = 1.17, 95% CI, 1.06-1.28; HR = 1.21, 95% CI, 1.08-1.37, respectively).
Our data demonstrate the continuing importance of HTN subtype transitions across age and their differences in predicting future CVD and total mortality.
高血压（HTN）已被证明是心血管疾病（CVD）发生和CVD死亡率的主要危险因素之一。
本研究根据1999年至2020年具有全国代表性的美国国家健康与营养检查调查（NHANES），基于2017年更新的美国心脏病学会/美国心脏协会（ACC/AHA）高血压定义，研究了高血压亚型（单纯舒张期高血压[IDH]、单纯收缩期高血压[ISH]和收缩期-舒张期高血压[SDH]）在年龄、性别和种族/族裔中的患病率及分布情况。我们还使用Cox回归分析进一步研究了每种亚型与CVD和全因死亡率之间的关联。
在美国成年人中，高血压的总体患病率为47.4%。随着年龄增长，IDH的患病率下降，ISH的患病率上升，SDH的患病率上升并在60岁时达到峰值，此后SDH患病率下降。到80岁时，超过80%的高血压患者表现为ISH。来自1999 - 2008年NHANES且随访至2018年的一个亚队列显示，ISH和SDH与CVD风险增加（HR = 1.18，95% CI，1.01 - 1.38；HR = 1.31，95% CI，1.07 - 1.60，分别）和全因死亡率增加（HR = 1.17，95% CI，1.06 - 1.28；HR = 1.21，95% CI，1.08 - 1.37，分别）的关联最为密切。
我们的数据表明高血压亚型随年龄转变的持续重要性及其在预测未来CVD和总死亡率方面的差异。
