Siscovick D S, Raghunathan T E, Psaty B M, Koepsell T D, Cobb L, Rautaharju P M, Wagner E H
Department of Medicine, University of Washington, Seattle, USA.
J Gen Intern Med. 1996 Jun;11(6):350-6. doi: 10.1007/BF02600046.
Previous studies have raised the concern that the reduction of diastolic blood pressure below 85 mm Hg among treated hypertensive patients may have cardiac hazards. However, these reports have not fully assessed potential confounding from coexisting cardiovascular disease.
We conducted a population-based case-control study to examine the relation between treated diastolic blood pressure and the risk of primary cardiac arrest among hypertensive patients free of clinically diagnosed cardiovascular disease. Cases were hypertensive enrollees of the Group Health Cooperative of Puget Sound, an HMO, who had primary cardiac arrest between 1977 and 1990 (n = 80). Control patients were a stratified random sample of hypertensive enrollees (n = 426). Ambulatory-care records were reviewed to assess blood pressures and other clinical characteristics. Medication use was assessed through the HMO computerised pharmacy database.
Logistic regression models suggested a curvilinear relation between the level of treated diastolic blood pressure and the risk of primary cardiac arrest, after adjustment for pretreatment diastolic blood pressure, antihypertensive therapy, and other potential confounders. Compared with a treated diastolic blood pressure of 85 mm Hg, a treated diastolic blood pressure of 80 mm Hg was associated with a small increase in risk (relative risk [RR] 1.2; 95% confidence interval [CI] 1.0, 1.6), 75 mm Hg was associated with a modest increase in risk [RR 1.6; 95% CI 1.2, 2.1], and 70 mm Hg was associated with more than a twofold increase in the risk of primary cardiac arrest [RR 2.3; 95% CI 1.4; 3.8). There was little evidence of effect modification by pretreatment diastolic blood pressure.
Our findings support available evidence that among hypertensive patients a treated diastolic blood pressure level below 85 mm Hg is associated with cardiac hazards.
既往研究引发了人们对接受治疗的高血压患者舒张压降至85mmHg以下可能存在心脏危害的担忧。然而，这些报告尚未充分评估并存心血管疾病带来的潜在混杂因素。
我们开展了一项基于人群的病例对照研究，以探讨接受治疗的舒张压与无临床诊断心血管疾病的高血压患者原发性心脏骤停风险之间的关系。病例为普吉特海湾卫生合作组织（一家健康维护组织）的高血压登记参与者，他们在1977年至1990年间发生了原发性心脏骤停（n = 80）。对照患者是高血压登记参与者的分层随机样本（n = 426）。回顾门诊护理记录以评估血压及其他临床特征。通过健康维护组织的计算机化药房数据库评估药物使用情况。
在对治疗前舒张压、抗高血压治疗及其他潜在混杂因素进行调整后，逻辑回归模型显示接受治疗的舒张压水平与原发性心脏骤停风险之间存在曲线关系。与治疗后舒张压85mmHg相比，治疗后舒张压80mmHg的风险略有增加（相对风险[RR] 1.2；95%置信区间[CI] 1.0，1.6），75mmHg的风险适度增加[RR 1.6；95% CI 1.2，2.1]，70mmHg的原发性心脏骤停风险增加两倍以上[RR 2.3；95% CI 1.4；3.8]。几乎没有证据表明治疗前舒张压存在效应修正。
我们的研究结果支持现有证据，即高血压患者治疗后舒张压水平低于85mmHg与心脏危害相关。
