海南省成年居民高血压与心脑血管疾病发病关系前瞻性队列研究

Relationship between hypertension and cardiovascular and cerebrovascular diseases among adult residents in Hainan province:a prospective cohort study

目的了解海南省成年居民高血压与心脑血管疾病发病的关系,为心脑血管疾病的预防控制提供参考依据。方法采用前瞻性队列研究方法,于2005年6月-2008年7月对在海南省美兰区整群抽取的30 000名30~79岁成年居民进行基线调查,随后开展长期随访,并采用单因素和多因素Cox回归模型分析海南省成年居民高血压与心脑血管疾病发病的关系。结果截至2013年12月31日,研究对象中有309人死亡,3人失访,失访率为0.01%;随访时间为0~9年,平均随访(6.7±1.4)年,累积随访175 667人年。随访结束时研究人群心血管疾病发病2 824例,累计发病率为10.8%;缺血性心脏病发病669例,累计发病率为2.6%;脑血管疾病发病2 059例,累计发病率为7.8%;出血性脑卒中发病91例,累计发病率为0.4%;缺血性脑卒中发病1 716例,累计发病率为6.5%。在控制了性别、年龄、文化程度、婚姻状况、是否吸烟、是否饮酒、体力活动水平、新鲜蔬菜摄入、新鲜水果摄入、红肉摄入、脑卒中家族史、急性心梗家族史、糖尿病患病情况和体质指数(BMI)等14个混杂因素后,多因素Cox回归分析结果显示,与血压正常者相比,高血压人群各类心脑血管疾病的发病风险均有所增加,HR值(95%CI)由大到小依次为出血性脑卒中[2.76(1.77~4.29)]、缺血性心脏病[1.25(1.06~1.49)]、心血管疾病[1.19(1.10~1.30)]、脑血管疾病[1.15(1.04~1.27)]和缺血性脑卒中[1.11(1.00~1.23)],单纯收缩期高血压人群依次为出血性脑卒中[1.79(1.07~3.00)]、缺血性心脏病[1.23(1.01~1.50)]和心血管疾病[1.15(1.04~1.27)],收缩舒张期高血压人群依次为出血性脑卒中[3.84(2.14~6.88)]、缺血性心脏病[1.45(1.10~1.91)]、心血管疾病[1.32(1.14~1.51)]、缺血性脑卒中[1.30(1.09~1.54)]和脑血管疾病[1.29(1.10~1.52)](均P <0.05)。结论高血压人群能增加不同心脑血管疾病的发病风险,收缩舒张期高血压增加幅度更大。

Objective To explore the relationship between hypertension and cardiovascular and cerebrovascular diseases among adult residents in Hainan province and to provide references for the prevention and control of cardiovascular and cerebrovascular diseases. Methods We conducted a prospective cohort study among 30 000 residents aged 30 – 79 years selected with cluster sampling in Meilan district of Hainan province. The baseline survey for the study was performed from June 2005 to July 2008 and then a long-term follow-up was conducted among the residents. Univariate and multivariate Cox regression were used to analyze the association of hypertension with cardiovascular and cerebrovascular diseases among the residents. Results Among all the residents, 309 deaths were observed and only 3(0.01%) were lost to follow-up till December 31, 2013;the follow-up time ranged from 0 to 9 years and the mean time was 6.7 ± 1.4 years, with a total of 175 667 person years of follow-up. By the end of the follow-up, the incidents and accumulated incidence rate were 2 824 and 10.8%for cardiovascular diseases, 669 and 2.6% for ischemic heart disease, 2 059 and 7.8% for cerebrovascular diseases, 91 and0.4% for haemorrhagic stroke, and 1 716 and 6.5% for ischaemic stroke, respectively. Multivariate Cox regression analysis indicated that compared to the residents with normal blood pressure, the residents with hypertension had significantly increased risks of cardiovascular and cerebrovascular diseases after adjusting for gender, age, education, marital status,smoking, alcohol drinking, diabetes, familial cardiovascular and cerebrovascular diseases history, body mass index(BMI),and other confounding factors, with the hazard ratios(HRs)(95% confidence interval [95% CI]) of 2.76(1.77 – 4.29) for haemorrhagic stroke, 1.25(1.06 – 1.49) for ischemic heart disease, 1.19(1.10 – 1.30) for cardiovascular disease, 1.15(1.04 –1.27) for cerebrovascular disease, and 1.11(1.00 – 1.23) for ischemic stroke;respectively;the residents with isolated systolic hypertension had significantly increased risks of haemorrhagic stroke(HR = 1.79, 95% CI: 1.07 – 3.00), ischemic heart disease(1.23, 1.01 – 1.50), and cardiovascular disease(1.15, 1.04 – 1.27);the residents with systolic-diastolic hypertension had significantly increased risks of haemorrhagic stroke(HR = 3.84, 95% CI: 2.14 – 6.88), ischemic heart disease(1.45,1.10 – 1.91), cardiovascular disease(1.32, 1.14 – 1.51), ischaemic stroke(1.30, 1.09 – 1.54), and cerebrovascular disease(1.29, 1.10 – 1.52). Conclusion Hypertension, especially systolic-diastolic hypertension increases the risks of cardiovascular and cerebrovascular diseases among adult community residents in Hainan province.