北京地区25～64岁人群高血压左心室肥厚与心血管事件和死亡的关系

Association between hypertensive left ventrieular hypertrophy and cardiovascular events in adult Beijing residents： a cohort study

目的分析北京地区25～64岁人群基线时高血压伴左心室肥厚与随访期间发生急性心血管病事件和死亡的关系。方法本研究对1984～1993年在北京地区采取分层随机抽样方法入选的25～64岁男女两性共7023人进行随访，对随访期间发生的急性心血管病事件和死亡进行登记，排除非高血压性左心室肥厚的211人后，应用Cox比例风险模型对高血压伴左心室肥厚与急性心血管病事件和死亡的关系进行分析。结果（1）基线7023人中有高血压2240例，高血压人群中左心室肥厚的患病率为11．8％，男性为16．1％，女性为7．5％。（2）与血压正常且无左心室肥厚者比较，高血压合并左心室肥厚者发生急性冠心病、急性脑卒中、总心血管病事件和总死亡的相对危险（RR）分别为4．92（95％CI：2．25，10．74）、4．24（95％CI：2．58，6．97）、4．06（95％CI：2．60，6．34）和3．26（95％C1：1．99，5．34）。（3）与有高血压但无左心室肥厚者比较，高血压合并左心室肥厚者发生急性冠心病、急性脑卒中、总心血管病事件和总死亡的RR分别为1．47（95％CI：0．71，3．05）、1．79（95％CI：1．14，2．80）、1．65（95％CI：1．19，2．28）和1．70（95％CI：1．08，2．69）。（4）急性冠心病、急性脑卒中、总心血管病事件和总死亡归因于高血压左心室肥厚的危险百分比（PARP）分别为13．0％、11．0％、10．4％和7．9％，其中男性急性脑卒中归因于高血压左心室肥厚的PARP为15．5％；女性急性冠心病归因于高血压左心室肥厚的PARP为21．7％。结论高血压左心室肥厚是急性心血管病发病和死亡的独立的预测指标。

Objective To analyze the impact of hypertensive left ventricular hypertrophy （LVH） on cardiovascular events （CVD） in adult Beijing residents. Methods CVD risk factor survey was conducted in 7023 Beijing residents aged 25-64 by a stratified-random sample design from 1984 to 1993 in three years interval. CVD events were followed up and the association of the hypertensive LVH and risk of CVD and total death was analyzed by multivariable Cox Regression Model. All subjects were followed up to December 2004. Results There were 211 non hypertensive LVH patients in the cohort and were excluded from the study. （ 1 ） There were 2240 hypertensive patients among 6812 subjects on baseline. The total prevalence of LVH was 11.8% （ 16. 1% in male and 7.5% in female）. （2） Compared to the group with normal blood pressure and without left ventricular hypertrophy, subjects with hypertensive LVH had significantly higher risk for acute coronary, acute stroke, total CVD and total death rate. The relative risks （ RR ） were 4. 92 （95%CI： 2.3, 10.7）,4.2 （95%C1： 2.6, 7.0）, 4.1 （95%CI： 2.6, 6.3） and 3.3 （95%CI： 2.0, 5.3）, respectively. （3） Compared to the group with hypertension and without LVH, the group with hypertensive LVH had also significantly higher risk for acute stroke, total CVD and total death rate. The RR were 1.8 （95%C1： 1.1, 2.8）, 1.7 （95% CI： 1.2, 2.3） and 1.7 （95%CI： 1.1, 2.7）, respectively. （4） The population attribute risks （PAR） of hypertensive LVH to the incidents of acute CHD, acute stroke, total CVD and total death were 13.0%, 11.0%, 10.4% and 7.9%, respectively. Conclusions Hypertensive left ventricular hypertrophy was an independent risk factor for long term risk of cardiovascular events and death.