正常高值血压:一个需要特别关注的血压阶段

High-normal Blood Pressure: A Blood Pressure Stage Needs Serious Attention

目的探讨正常高值血压概念存在的重要性及早期对之进行干预的必要。方法1992年和2007年，对成都市同一人群（711人）进行了心血管疾病（CVD）危险因素的调查，除去1992年已诊断为高血压的114例患者，将剩余的597人分为正常血压组[〈120／80mmHg（1mmHg=0．133kPa）]和正常高值血压组[收缩压120～139mm／1Hg和（或）舒张压80～89mmHg]。对前后两次资料进行分析以探讨正常高值血压与高血压及相关CVD危险因素的关系。结果1992年正常高值血压组的CVD危险因素水平高于正常血压组，到2007年时这种差别仍存在。正常高值血压组的15年累计高血压发病率（91．2％）远高于正常血压组（22．2％），差异有统计学意义（P〈0．05）；对血脂及体质量等危险因素进行校正后，正常高值血压仍可预测高血压的形成[HR=5．354，95％CI（4．094，7．002），P=0．001]。1992年两组人群的CVD患病率差异无统计学意义（P〈0．05），但15年后正常高值血压组的CVD患病率（6．6％）呈高于正常血压组（3．1％）的趋势（P=0．052）。结论正常高值血压是一个特殊的血压阶段，其更易进展为高血压并持续伴随较高水平的心血管疾病危险因素；为预防相关心血管疾病的发生发展，需要对正常高值血压及相关心血管疾病的危险因素进行早期干预。

Objective To investigate the significance of using the term ＂high-normal blood pressure＂ and its intervention in the early stage. Methods In 1992 and 2007, we performed two similar investigations focusing on cardiovascular risk factors in 711 people in Chengdu city. Since 114 individuals were diagnosed with hypertension, 597 people without hypertension were eligible and divided into two groups： the normal-pressure [ 〈 120/80 mm Hg （1 mm Hg=0.133 kPa）] group and the high-normal blood pressure （systolic blood pressure 120-139 mm Hg and/or diastolic blood pressure 80-89 mm Hg） group. Data in the two investigations were compared to explore the relationship among high- normal blood pressure, cardiovascular disease （CVD） and hypertension. Results The high-normal blood pressure group had a higher level of CVD risk factors both in 1992 and 2007, and the 15-year cumulative incidence of hypertension in the high-normal blood pressure group was higher than that of n0rmal-pressure group （91.2% vs. 22.2%, P 〈 0.001）. After adjusting for serum lipid, body weight and other CVD risk factors, high-normal blood pressure could predict the progression into hypertension [HR=5.354, 95% CI （4.094, 7.002）, P=0.001]. There was no statistics difference in CVD prevalence in the two groups in 1992, but in 2007 the prevalence of CVD tended to be higher in the high-normal blood pressure group （6.6% vs. 3.1%,P=0.052）. Conclusions High-normal blood pressure is a special stage of blood pressure with high level of CVD risk factors and high potential to progress into hypertension. The term should be emphasized and intervention should be done in the early stage for high-normal blood pressure people to prevdiat from hypertension and CVD.