中国35～64岁人群15年高血压发生风险预测研究

Prediction models for the 15 years risk of new-onset hypertension in Chinese people aged from 35 to 64 years old

目的 建立适合中国人群的高血压预测模型,并建立方便应用的风险评分表.方法 采用前瞻性队列研究方法,对1992年建立的11省市35 ～ 64岁队列人群基线危险因素水平及15年内发生的高血压病进行多因素logistic回归分析,通过回归系数建立高血压预测模型及风险评分表,同时对模型性能进行评价.结果 纳入本次分析的3 899人15年内共有1 776例发生了高血压,高血压累计发病率为45.6％.分别建立两个高血压预测模型,模型1纳入了年龄、收缩压、舒张压、BMI、高血压家族史5个危险因素,模型2在模型1的基础上加入了TG和HDL-C.模型1和模型2都有很好的判别能力（模型1的C统计量为0.716 8,模型2者为0.720 8,P=0.018 6）和校准能力（模型1的x2值为3.75,模型2为3.10）.两模型比较得出的重新分类净改善（NRI）指数为0.83％,P=0.40.结论 高血压预测模型能够识别高血压发生高危个体,有助于医生的临床决策,并为高风险者改善生活习惯提供数据支持.

Objective To set up prediction models for the risk of new-onset hypertension in Chinese people and explore the risk scores to facilitate the clinical application.Methods A cohort set up since 1992 with participants aged 35-64 years old from 11 provinces and cities of China was prospectively studied.Logistic regression was used to analyze the risk factors for the incidence of hypertension within 15 years and the prediction models and risk scores were developed with the regression coefficient.The performance of the prediction models were tested and compared with the Framingham model.Results A total of 3 899participants free from hypertension at baseline with 15 years follow-up were enrolled in the study.Within 15 years,1 776 cases of incident hypertension were ascertained with a incidence rate of 45.6%.Two prediction models were set up with age,systolic blood pressure,diastolic blood pressure,BMI and the history of parental hypertension in the Model 1,while TG and HDL-C added on the basis of Model 1 in the Model 2.Good performance of discrimination and calibration was established in both models with significant difference in C statistics and no significant difference in net reclassification improvement （NRI） index.Conclusion The hypertension risk prediction models can be used to estimate an individual＇s absolute risk for hypertension and could facilitate the management of potential hypertension patients.