中国35～64岁人群血压水平与10年心血管病发病危险的前瞻性研究

A prospective study of relationship between blood pressure and 10-year cardiovascular risk in a Chinese cohort aged 35-64 years

目的 探讨我国 35～ 6 4岁人群血压水平与心血管病发病危险的关系 ,为《中国高血压防治指南》的修订工作提供流行病学数据。方法 采用前瞻性队列研究的方法 ,对 1992年建立的 11省市 35～ 6 4岁队列人群共 3172 8人的基线血压水平和 1992～ 2 0 0 2年发生的心血管病 (包括冠心病和脑卒中 )事件的关系进行分析。结果 (1)以血压 110～ 119/ 75～ 79mmHg(1mmHg =0 133kPa)为对照 ,血压在 12 0～ 12 9/ 80～ 84mmHg时 ,心血管病发病危险增加了 1倍 (RR =2 0 9) ;血压在 14 0～ 14 9/90～ 94mmHg时 ,心血管病发病危险增加了 2倍以上 (RR =3 2 3) ;当血压≥ 180 / 110mmHg时 ,心血管病发病危险增加了 10倍以上 (RR =11 81)。 (2 )与理想血压相比 ,2级高血压时 ,急性冠心病事件发病的危险是理想血压组的 2 3倍 ,急性缺血性脑卒中和急性出血性脑卒中发病的危险分别是理想血压组的 4 9倍和 11 7倍。 (3)在总的心血管病事件中 ,36 1%可归因于高血压 ;其中 4 4 0 %的急性脑卒中事件和 2 3 7%的急性冠心病事件可归因于高血压。 (4 )不同血压水平时 ,随着合并其他心血管病危险因素个数的增加 ,10年心血管病发病的综合危险增加。结论 血压水平从 110 / 75mmHg开始 ,随着血压水平的增加 。

Objective To provide epidemiologica l data for the revision of The National Guideline for Prevention and Treatment of Hypertension through the analysis of the association between blood pressure ( BP) and the risk of cardiovascular diseases (CVD) in a cohort aged 35-64 years . Methods A prospective study was carried out in 11 provinc es from 1992 to 2002. The association between BP and CVD (CHD and stroke) was an alyzed in 31728 subjects aged 35-64 years. Results (1) Compared with BP<110/75 mm Hg, the risk of CV D increased 1 time (RR=2.09), 2 times (RR=3.23), and 10 times (RR=11.81) when BP was 120-129/80-84 mm Hg, 140-149/90-94 mm Hg, and≥180/110 mm Hg, re spectively. (2) The risk of acute CHD for subjects with stage 2 hypertension was 2.3 times of those with optimal BP, whereas the risk of ischemic stroke and he morrhagic stroke was 4.9 times and 11.7 times, respectively. (3) 36.1% of all CVDs, 44.0% of the acute stroke and 23.7% of the comacute CHD were attributa ble to hypertension. (4) In each BP level, the 10-year risk of CVD increased w ith the increased number of other risk factors.Conclusions The risk of CVD increases with BP continuousl y from BP of 110/75 mmHg. Therefore, the cutpoint of the diagnostic criteria for hypertension is arbitrary. Comprehensive intervention for multiple risk factor clustering should be strengthened to reduce the overall risk of CVD.