Flack J M, Neaton J, Grimm R, Shih J, Cutler J, Ensrud K, MacMahon S
Hypertension Division, Bowman Gray School of Medicine, Winston-Salem, NC 27157-1032, USA.
Circulation. 1995 Nov 1;92(9):2437-45. doi: 10.1161/01.cir.92.9.2437.
The purpose of the present study was to describe the relation between blood pressure (systolic [SBP] and diastolic [DBP]) and death from coronary heart disease (CHD) and all causes for men with a history of myocardial infarction (MI).
The study cohort consisted of men aged 35 to 57 years screened for the Multiple Risk Factor Intervention Trial (MRFIT) in 1973 through 1975 and followed for survival for an average of 16 years through 1990. There were 5362 men who reported prior hospitalization for a heart attack of at least 2 weeks' duration at the initial screening of MRFIT. There was a J-shaped relation between SBP and DBP with both CHD and all-cause mortality during the first 2 years of follow-up in older (age, 45 to 57 years) men only. Risk nadirs for SBP were 152 and 145 mm Hg, respectively, for CHD death and all-cause mortality; corresponding DBP risk nadirs were 94 and 90 mm Hg. After the first 2 years, there was a positive association between SBP and death from CHD and all causes. By 15 years, cumulative CHD mortality percentages for men with screening SBP < 120, 120 to 139, 140 to 159, and > or = 160 mm Hg were 19.7%, 21.3%, 27.5%, and 32.0%, respectively. When deaths only after year 2 were considered, although the linear DBP coefficient was significant, the quadratic term for DBP was no longer significant (P > .05). However, the relation still appeared J-shaped as cumulative mortality for those with DBP < 70, 70 to 79, 80 to 89, 90 to 99, and > or = 100 mm Hg was 24.3%, 20.8%, 21.1%, 25.5%, and 29.7%, respectively. When the joint relation of SBP and DBP was considered, there were no survival differences among the four cohorts (SBP > or = 140 and DBP < 80, SBP > or = 140 and DBP > or = 80, SBP < or = 140 and DBP < 80, and SBP < or = 140 and DBP > or = 80) during the first 2 years. After 2 years, both CHD and all-cause mortality rates were approximately 40% higher for participants with SBP > or = 140 mm Hg versus < 140 mm Hg regardless of DBP level (< 80 or > or = 80 mm Hg).
In this large cohort of men with prior MI, the association of SBP and DBP with CHD and all-cause mortality varied over the 16-year follow-up period. During early follow-up, in older men only, J- or U-shaped relations were evident. However, after 2 years, these same relations had become positive and graded. Given the substantial excess mortality risk in this cohort associated with high blood pressure, particularly SBP, efforts to gradually lower blood pressure should receive high priority among hypertensive men with prior MI.
本研究的目的是描述有心肌梗死（MI）病史的男性的血压（收缩压[SBP]和舒张压[DBP]）与冠心病（CHD）死亡及全因死亡之间的关系。
研究队列包括1973年至1975年接受多重危险因素干预试验（MRFIT）筛查的35至57岁男性，并随访其生存情况至1990年，平均随访16年。在MRFIT初始筛查时有5362名男性报告曾因持续至少2周的心脏病发作住院治疗。仅在年龄较大（45至57岁）的男性随访的前2年中，SBP和DBP与CHD及全因死亡率之间呈J形关系。CHD死亡和全因死亡率的SBP风险最低点分别为152和145 mmHg；相应的DBP风险最低点为94和90 mmHg。在最初2年后，SBP与CHD死亡及全因死亡之间呈正相关。到15年时，筛查SBP<120、120至139、140至159以及≥160 mmHg的男性的累积CHD死亡率分别为19.7%、21.3%、27.5%和32.0%。仅考虑第2年后的死亡情况时，虽然DBP的线性系数显著，但DBP的二次项不再显著（P>.05）。然而，这种关系仍呈J形，因为DBP<70、70至79、80至89、90至99以及≥100 mmHg者的累积死亡率分别为24.3%、20.8%、21.1%、25.5%和29.7%。考虑SBP和DBP的联合关系时，在最初2年中四个队列（SBP≥140且DBP<80、SBP≥140且DBP≥80、SBP≤140且DBP<80以及SBP≤140且DBP≥80）之间没有生存差异。2年后，无论DBP水平（<80或≥80 mmHg）如何，SBP≥140 mmHg的参与者的CHD和全因死亡率均比SBP<140 mmHg者高约40%。
在这个有既往MI病史的大型男性队列中，SBP和DBP与CHD及全因死亡率的关联在16年随访期内有所变化。在早期随访中，仅在年龄较大的男性中，J形或U形关系明显。然而，2年后，这些相同的关系变为正相关且呈梯度变化。鉴于该队列中与高血压尤其是SBP相关的过高死亡风险，对于有既往MI病史的高血压男性，应高度重视逐步降低血压的努力。
