高血压前期人群中心脑血管事件发生情况及影响因素

The incidence of cardiovascular events and its related risk factors in prehypertensive population

目的观察高血压前期人群中心脑血管事件发生情况及影响因素。方法采用前瞻性队列研究方法,以参加2006-07-2007-10健康查体的30～70岁开滦集团在职及离退休职工101510人中,符合美国预防、检测、评估与治疗高血压全国联合委员会第7次报告(JNC7)高血压前期诊断标准(30027人)和理想血压诊断标准(15614人)的人群作为观察队列。随访38.0～53.0(47.6±3.2)月,随访期间每半年收集1次新发心脑血管事件情况。观察高血压前期人群中心脑血管事件发生率并用多变量Cox比例风险回归模型分析影响心脑血管事件的因素。结果与理想血压人群相比高血压前期人群的平均年龄较大;男性比例较高;三酰甘油、总胆固醇、低密度脂蛋白胆固醇和体质量指数水平高(均P<0.05)。随访期间共发生461例心脑血管事件。高血压前期人群中总心脑血管事件、脑梗死、脑出血、心肌梗死和心脑血管病致死事件的累积发生率分别为1.19%、0.57%、0.20%、0.23%和0.23%,高于理想血压人群的0.67%、0.27%、0.12%、0.17%和0.15%,其中总心脑血管事件、脑梗死和脑出血累积发生率两组人群差异有统计学意义(均P<0.05)。校正其他传统心血管危险因素后,高血压前期人群发生总心脑血管事件和脑梗死的RR分别较理想血压人群增加37%(95%CI1.10～1.70)和56%(95%CI1.10～2.20)。结论高血压前期人群的总心脑血管事件、脑梗死和脑出血累积发生率高于理想血压人群;高血压前期是总心脑血管事件和脑梗死的独立危险因素。

Objective To observe the incidence of cardiovascular events and its related risk factors in prehypertensives.Methods In this prospective cohort study,the data was derived from the KaiLuan study cohort（101 510 cases）.A total of 30 027 prehypertensives and 15 614 normotensives（defined by the JNC 7） were enrolled（aged 30-70 years,no cardiovascular disease）.Cardiovascular events included cerebral infarction,cerebral hemorrhage,myocardial infarction and definite fatal CVD.The study was followed for an average of 38.0-53.0（47.6±3.2） months.New cardiovascular events were recorded every six months and the incidence of cardiovascular events was observed.Cox proportional hazard ratios were calculated to assess relative risk of cardiovascular events.Results Compared to normotensive group,the average age and the proportion of male were higher in prehypertension group.In addition,the average levels of TG,TC,LDL-C and BMI were also higher in prehypertension group（P0.05）.There were 461 cardiovascular events recorded during the follow up period.In prehypertensives,the incidence rates of cardiovascular events,cerebral infarction,cerebral hemorrhage,myocardial infarction and definite fatal CVD were 1.19%,0.57%,0.20%,0.23% and 0.23%,while in the normotensives were 0.67%,0.27%,0.12%,0.17% and 0.15%.All the incidence rates of CVD events in prehypertensives were higher than those in normotensives,particularly the incidence of cardiovascular events,cerebral infarction and cerebral hemorrhage（all P0.05）.After adjusted for other traditional cardiovascular risk factors,prehypertension was associated with 37% higher risk of cardiovascular events（HR 1.37 95% CI 1.10-1.70） and 56% higher risk of cerebral infarction（HR 1.56,95% CI 1.10-2.20） than normotensives.Conclusions In this community-based Kailuan cohort,the cumulative incidence of cardiovascular events,cerebral infarction and cerebral hemorrhage in prehypertensives was higher than that in normotensives.Prehypertension was associated with increased risk of cardiovascular events and cerebral infarction independent of other cardiovascular risk factors.