Rocha E, Gouveia-Oliveira A, Cotter A, Laranjeiro A, Sousa A, Mendes F, Teixeira H, Galvão J, Miguel J M
Centro de Estudos de Cardiologia Preventiva, INSA, Lisboa.
Rev Port Cardiol. 1997 Jun;16(6):543-56, 508.
To identify stroke risk factors in hypertensive patients and the probability of stroke in relation to those risk factors and follow-up.
A cohort study (patients with high blood pressure).
707 hypertensive patients were studied (Hypertension Register) in what concerns stroke incidence until 1992 (n = 126), considering one case per individual. The following variables were analysed: age, sex, body mass index (Quetelet), systolic and diastolic blood pressure, heart rate, types of hypertension (JNC-IV), left ventricular hypertrophy, changes in ST segment and T wave (Minnesota Code), fundi, angina pectoris, heart failure, central nervous (neurological) disturbances, antihypertensive treatment, smoking, serum potassium, serum sodium, blood urea, creatinine, uric acid, blood sugar, diabetes and cholesterol, in the initial record. Individually, in relation to the control of hypertension, the subjects were classified according to the casual recording of normal blood pressure, the absence of drug treatment, diastolic pressure > 114 mmHg and, at the end of 1992, according to survival, causes of death and follow-up. Stroke risk factors have been identified by multivariate analysis (Cox regression model). The survival probability (without stroke) was defined by Kaplan-Meier method.
It was possible to maintain the epidemiological surveillance, from 1975 to 1992, of 598 cases. From those, 109 hypertensive patients were victims of at least one episode of non transient cerebral ischaemia, during their follow-up of 10.5 years. From the characteristics studied, only five were identified at risk factors. The adjusted relative risks and confidence intervals (95% CI) were the following: age: 1.08 (1.06-1.10); diastolic pressure > 114 mmHg: 1.96 (1.32-2.91); neurological disturbances 4.64 (2.99-7.2); diabetes: 2.57 (1.62-4.05) and left ventricular hypertrophy: 1.34 (1.13-1.58).
As far as stroke is concerned: a) Age, diabetes, a casual measurement of diastolic blood pressure > 114 mmHg and left ventricular hypertrophy (electrocardiogram) were the risk factors identified; b) Prevention should include blood pressure and diabetes control, although this disease has shown more risk than a casual measurement of severe hypertension; c) Its occurrence, in this model, has only partly been explained, therefore it has become necessary to deepen the study of the risk profile.
确定高血压患者的中风危险因素，以及与这些危险因素和随访相关的中风发生概率。
一项队列研究（高血压患者）。
对707名高血压患者（高血压登记册）进行了关于中风发病率的研究，直至1992年（n = 126），每人计为1例。分析了以下变量：年龄、性别、体重指数（克托莱指数）、收缩压和舒张压、心率、高血压类型（美国国家联合委员会第四版）、左心室肥厚、ST段和T波变化（明尼苏达编码）、眼底、心绞痛、心力衰竭、中枢神经（神经）紊乱、抗高血压治疗、吸烟、血清钾、血清钠、血尿素、肌酐、尿酸、血糖、糖尿病和胆固醇，均为初始记录中的数据。就高血压控制情况而言，根据偶然测得的正常血压、未进行药物治疗、舒张压>114 mmHg，以及在1992年底，根据生存情况、死亡原因和随访情况，对受试者进行了分类。通过多变量分析（Cox回归模型）确定了中风危险因素。生存概率（无中风）采用Kaplan-Meier法定义。
从1975年至1992年，对598例病例进行了流行病学监测。其中，109名高血压患者在10.5年的随访期间至少发生过一次非短暂性脑缺血发作。在所研究的特征中，仅确定了五个危险因素。调整后的相对风险和置信区间（95%CI）如下：年龄：1.08（1.06 - 1.10）；舒张压>114 mmHg：1.96（1.32 - 2.91）；神经紊乱：4.64（2.99 - 7.2）；糖尿病：2.57（1.62 - 4.05）；左心室肥厚：1.34（1.13 - 1.58）。
就中风而言：a）年龄、糖尿病、偶然测得的舒张压>114 mmHg和左心室肥厚（心电图）是确定的危险因素；b）预防应包括控制血压和糖尿病，尽管这种疾病显示出的风险比偶然测得的重度高血压更大；c）在这个模型中，中风的发生仅得到了部分解释，因此有必要深入研究风险概况。
