Perneger T V, Klag M J, Feldman H I, Whelton P K
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Md.
JAMA. 1993 Mar 10;269(10):1272-7.
To establish nationwide projections for hypertension-related renal disease among middle-aged residents of the United States and compare disease burden in demographic subgroups.
Integrated analysis of data from the US Census, the National Health and Nutrition Examination Survey of 1976 through 1980 (NHANES II), the 1971 through 1975 NHANES I Epidemiologic Follow-up Study, the Hypertension Detection and Follow-up Program trial, and the US Renal Data System.
African-American and white residents of the United States, aged 30 to 69 years.
Incidence rates and counts of hypertension, hypertension-related hypercreatinemia, and hypertension-related end-stage renal disease (ESRD).
Each year, approximately 1.8 million middle-aged Americans develop hypertension, 140,000 develop hypertension-related hypercreatinemia, and 5300 develop hypertension-related ESRD. African Americans are at increased risk for hypertension (relative risk [RR], 1.6; population-attributable risk [PAR], 5%), hypercreatinemia if hypertensive (RR, 2.4; PAR, 18%), ESRD if hypertensive with hypercreatinemia (RR, 2.7; PAR, 32%), and hypertension-related ESRD overall (RR, 8.0; PAR, 44%). Compared with women, men are at increased risk for hypertension (RR, 1.3; PAR, 13%) and hypertension-related ESRD (RR, 1.6; PAR, 23%). Most cases of hypercreatinemia in hypertensives (73%) occur among those with mild hypertension.
Progression to ESRD is rare in persons with hypertension-related renal disease, and factors other than blood pressure probably play an important role. A large proportion of hypertension-related renal disease cases occur among population subgroups considered to be at low risk. Interventions that favorably influence factors associated with the progression of hypertension-related renal disease in African Americans, in men, and in persons with mild hypertension, hold the greatest potential for reducing the population burden of hypertension-related ESRD.
对美国中年居民中与高血压相关的肾病进行全国性预测，并比较不同人口亚组的疾病负担。
对来自美国人口普查、1976年至1980年全国健康和营养检查调查（NHANES II）、1971年至1975年NHANES I流行病学随访研究、高血压检测与随访项目试验以及美国肾脏数据系统的数据进行综合分析。
年龄在30至69岁之间的美国非裔和白人居民。
高血压、高血压相关的高肌酐血症以及高血压相关终末期肾病（ESRD）的发病率和病例数。
每年，约180万美国中年人患高血压，14万人患高血压相关的高肌酐血症，5300人患高血压相关的ESRD。非裔美国人患高血压的风险增加（相对风险[RR]，1.6；人群归因风险[PAR]，5%），高血压患者患高肌酐血症的风险增加（RR，2.4；PAR，18%），高血压合并高肌酐血症患者患ESRD的风险增加（RR，2.7；PAR，32%），总体上患高血压相关ESRD的风险增加（RR，8.0；PAR，44%）。与女性相比，男性患高血压的风险增加（RR，1.3；PAR，13%）以及患高血压相关ESRD的风险增加（RR，1.6；PAR，23%）。高血压患者中大多数高肌酐血症病例（73%）发生在轻度高血压患者中。
高血压相关肾病患者进展为ESRD的情况很少见，血压以外的因素可能起重要作用。很大一部分高血压相关肾病病例发生在被认为低风险的人群亚组中。对非裔美国人、男性以及轻度高血压患者中与高血压相关肾病进展相关因素产生有利影响的干预措施，在减轻高血压相关ESRD的人群负担方面具有最大潜力。
