Prentice R L, Shimizu Y, Lin C H, Peterson A V, Kato H, Mason M W, Szatrowski T P
Am J Epidemiol. 1982 Jul;116(1):1-28. doi: 10.1093/oxfordjournals.aje.a113384.
A cohort of 16,711 residents of Hiroshima and Nagasaki have participated in a program of biennial clinical examination and history taking that began in 1958. During 1958-1974, a total of 621 confirmed cases of cerebrovascular disease and 218 confirmed cases of coronary heart disease were incident. This study makes a detailed examination of the relationship between a series of biennial examination blood pressure (BP) measurements and cardiovascular disease risk. Two aspects are emphasized: the quantitative relationship between risk and both systolic blood pressure (SBP) and diastolic blood pressure (DBP), and the predictive value of BP levels some years in the past, given more recent BP determinations. Cerebral hemorrhage incidence is shown to depend markedly on recent DBP level, while earlier DBP levels make an additional important contribution to risk prediction. Corresponding SBP levels have little additional predictive value. With cerebral infarction, SBP is the more important predictor, though elevated DBP conveys some additional risk at high SBP levels. Recent BP levels are more strongly predictive for cerebral infarction than are BP levels some years earlier. Elevated SBP is also an important predictor of coronary heart disease risk in this population, while elevated DBP does not appear to be predictive at specified SBP. SBP levels several years in the past are more closely associated with coronary heart disease risk than are recent SBP readings. The dependence of BP relative risk functions on sex and age is examined and some departures from the results just listed are noted at younger ages. Implications for disease mechanism and hypertensive therapy are discussed.
1958年起，广岛和长崎的16711名居民参与了一项每两年进行一次临床检查和病史采集的项目。1958年至1974年期间，共出现621例确诊的脑血管疾病病例和218例确诊的冠心病病例。本研究详细考察了一系列每两年测量一次的血压（BP）与心血管疾病风险之间的关系。重点关注两个方面：风险与收缩压（SBP）和舒张压（DBP）之间的定量关系，以及过去几年的血压水平在近期血压测定情况下的预测价值。脑出血发病率明显取决于近期的DBP水平，而早期的DBP水平对风险预测也有重要的额外贡献。相应的SBP水平几乎没有额外的预测价值。对于脑梗死，SBP是更重要的预测指标，不过在高SBP水平时，升高的DBP会带来一些额外风险。近期的血压水平对脑梗死的预测比几年前的血压水平更强。在该人群中，升高的SBP也是冠心病风险的重要预测指标，而在特定的SBP水平下，升高的DBP似乎没有预测作用。过去几年的SBP水平比近期的SBP读数与冠心病风险的关联更紧密。研究了BP相对风险函数对性别和年龄的依赖性，并注意到在较年轻年龄段与上述结果存在一些偏差。还讨论了对疾病机制和高血压治疗的影响。
