Cook N R, Cohen J, Hebert P R, Taylor J O, Hennekens C H
Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
Arch Intern Med. 1995 Apr 10;155(7):701-9.
To estimate the impact of small reductions in the population distribution of diastolic blood pressure (DBP), such as those potentially achievable by population-wide lifestyle modification, on incidence of coronary heart disease (CHD) and stroke.
Published data from the Framingham Heart Study, a longitudinal cohort study, and from the National Health and Nutrition Examination Survey II, a national population survey, were used to examine the impact of a population-wide strategy aimed at reducing DBP by an average of 2 mm Hg in a population including normotensive subjects.
SETTING/PARTICIPANTS: White men and women aged 35 to 64 years in the United States.
Incidence of CHD and stroke, including transient ischemic attacks (TIAs).
Data from overviews of observational studies and randomized trials suggest that a 2-mm Hg reduction in DBP would result in a 17% decrease in the prevalence of hypertension as well as a 6% reduction in the risk of CHD and a 15% reduction in risk of stroke and TIAs. From an application of these results to US white men and women aged 35 to 64 years, it is estimated that a successful population intervention alone could reduce CHD incidence more than could medical treatment for all those with a DBP of 95 mm Hg or higher. It could prevent 84% of the number prevented by medical treatment for all those with a DBP of 90 mm Hg or higher. For stroke (including TIAs), a population-wide 2-mm Hg reduction could prevent 93% of events prevented by medical treatment for those with a DBP of 95 mm Hg or higher and 69% of events for treatment for those with a DBP of 90 mm Hg or higher. A combination strategy of both a population reduction in DBP and targeted medical intervention is most effective and could double or triple the impact of medical treatment alone. Adding a population-based intervention to existing levels of hypertension treatment could prevent an estimated additional 67,000 CHD events (6%) and 34,000 stroke and TIA events (13%) annually among all those aged 35 to 64 years in the United States.
A small reduction of 2 mm Hg in DBP in the mean of the population distribution, in addition to medical treatment, could have a great public health impact on the number of CHD and stroke events prevented. Whether such DBP reductions can be achieved in the population through lifestyle interventions, in particular through sodium reduction, depends on the results of ongoing primary prevention trials as well as the cooperation of the food industry, government agencies, and health education professionals.
评估舒张期血压（DBP）人群分布的小幅降低（如通过全人群生活方式改变可能实现的降低幅度）对冠心病（CHD）和中风发病率的影响。
使用来自弗明汉心脏研究（一项纵向队列研究）以及第二次全国健康和营养检查调查（一项全国性人群调查）的已发表数据，来检验一项旨在使包括血压正常者在内的人群平均DBP降低2 mmHg的全人群策略的影响。
地点/参与者：美国35至64岁的白人男性和女性。
冠心病和中风的发病率，包括短暂性脑缺血发作（TIA）。
观察性研究和随机试验综述的数据表明，DBP降低2 mmHg将导致高血压患病率降低17%，冠心病风险降低6%，中风和TIA风险降低15%。将这些结果应用于美国35至64岁的白人男性和女性后估计，仅成功的人群干预对冠心病发病率的降低幅度就可能超过对所有DBP为95 mmHg或更高者的药物治疗。对于所有DBP为90 mmHg或更高者，它可以预防药物治疗所预防数量的84%。对于中风（包括TIA），全人群DBP降低2 mmHg可预防DBP为95 mmHg或更高者药物治疗所预防事件的93%，以及DBP为90 mmHg或更高者治疗所预防事件的69%。DBP人群降低与针对性药物干预相结合的策略最为有效，可能使单独药物治疗的影响加倍或增至三倍。在美国35至64岁的所有人中，在现有高血压治疗水平基础上增加基于人群的干预措施，估计每年可额外预防67000例冠心病事件（6%）和34000例中风及TIA事件（13%）。
除药物治疗外，人群分布均值中DBP小幅降低2 mmHg可能对预防冠心病和中风事件的数量产生重大公共卫生影响。能否通过生活方式干预，特别是通过减少钠摄入，在人群中实现这种DBP降低，取决于正在进行的一级预防试验结果以及食品行业、政府机构和健康教育专业人员的合作。
