Du X, Cruickshank K, McNamee R, Saraee M, Sourbutts J, Summers A, Roberts N, Walton E, Holmes S
School of Epidemiology and Health Sciences, University of Manchester Medical School.
BMJ. 1997 Jan 25;314(7076):272-6. doi: 10.1136/bmj.314.7076.272.
To examine the risk of stroke in relation to quality of hypertension control in routine general practice across an entire health district.
Population based matched case-control study.
East Lancashire Health District with a participating population of 388,821 aged < or = 80.
Cases were patients under 80 with their first stroke identified from a population based stroke register between 1 July 1994 and 30 June 1995. For each case two controls matched with the case for age and sex were selected from the same practice register. Hypertension was defined as systolic blood pressure > or = 160 mm Hg or diastolic blood pressure > or = 95 mm Hg, or both, on at least two occasions within any three month period or any history of treatment with antihypertensive drugs.
Prevalence of hypertension and quality of control of hypertension assessed by using the mean blood pressure recorded before stroke) and odds ratios of stroke (derived from conditional logistic regression).
Records of 267 cases and 534 controls were examined; 61% and 42% of these subjects respectively were hypertensive. Compared with non-hypertensive subjects hypertensive patients receiving treatment whose average pre-event systolic blood pressure was controlled to < 140 mm Hg had an adjusted odds ratio for stroke of 1.3 (95% confidence interval 0.6 to 2.7). Those fairly well controlled (140-149 mm Hg), moderately controlled (150-159 mm Hg), or poorly controlled (> or = 160 mm Hg) or untreated had progressively raised odds ratios of 1.6, 2.2, 3.2, and 3.5 respectively. Results for diastolic pressure were similar; both were independent of initial pressures before treatment. Around 21% of strokes were thus attributable to inadequate control with treatment, or 46 first events yearly per 100,000 population aged 40-79.
Risk of stroke was clearly related to quality of control of blood pressure with treatment. In routine practice consistent control of blood pressure to below 150/90 mm Hg seems to be required for optimal stroke prevention.
在整个健康区的常规全科医疗中，研究与高血压控制质量相关的中风风险。
基于人群的配对病例对照研究。
东兰开夏郡健康区，参与研究的人群年龄≤80岁，共388,821人。
病例为1994年7月1日至1995年6月30日期间从基于人群的中风登记册中确诊的首次中风且年龄在80岁以下的患者。对于每个病例，从同一诊所登记册中选取两名年龄和性别与之匹配的对照。高血压定义为在任何三个月期间内至少两次收缩压≥160 mmHg或舒张压≥95 mmHg，或两者兼有，或有任何抗高血压药物治疗史。
高血压患病率以及通过中风前记录的平均血压评估的高血压控制质量，以及中风的比值比（源自条件逻辑回归）。
检查了267例病例和534例对照的记录；这些受试者中分别有61%和42%患有高血压。与非高血压受试者相比，治疗前平均收缩压控制在<140 mmHg的高血压患者发生中风的调整后比值比为1.3（95%置信区间0.6至2.7）。那些血压控制较好（140 - 149 mmHg）、中度控制（150 - 159 mmHg）、控制不佳（≥160 mmHg）或未治疗的患者的比值比逐渐升高，分别为1.6、2.2、3.2和3.5。舒张压的结果相似；两者均与治疗前的初始血压无关。因此，约21%的中风可归因于治疗控制不足，即每100,000名40 - 79岁的人群中每年有46例首次中风事件。
中风风险显然与治疗时血压的控制质量相关。在常规医疗中，为了实现最佳的中风预防，似乎需要将血压持续控制在150/90 mmHg以下。
