最新血压标准变化下高血压与心血管疾病关联  

Association between hypertension and cardiovascular disease under the latest changes in blood pressure standards

作　　者：孙慧宇 常琴雪 李长平[1] 刘媛媛[1] 崔壮[1] SUN Hui-yu;CHANG Qin-xue;LI Chang-ping;LIU Yuan-yuan;CUI Zhuang(School of Public Health,Tianjin Medical University,Tianjin 300070,China;不详)

机构地区：[1]天津医科大学公共卫生学院,天津300070 [2]天津市河东区大王庄街社区卫生服务中心

出　　处：《现代预防医学》2022年第21期3848-3852,3888,共6页Modern Preventive Medicine

基　　金：国家自然科学基金项目(81200611);教育部人文社科规划基金项目(17YJAZH048)。

摘　　要：目的本文探究了2020ISH高血压指南与2017ACC/AHA高血压指南定义下的血压标准与天津市老年人特别是原定义为高值血压现定义为正常血压人群的心血管疾病发生风险的关联,为进一步评价2020ISH新指南定义标准在预防心血管疾病的应用中提供参考。方法基于2014年进入天津市居民健康档案队列,通过整群抽样,选取天津市部分地区60岁以上191043名老年人的血压测量随访数据。血压诊断采用2种标准:2017ACC/AHA高血压指南、2020ISH高血压指南。统计学方法采用卡方检验、独立样本t检验及Cox比例风险模型。结果介于120/80mmHg与130/85mmHg之间的血压值在2017年ACC/AHA指南中为高值血压,但在2020年ISH新的血压指南中为正常血压。此区间的51605名老年人群发生主要心血管事件的风险HR=1.248,95%CI:1.187~1.313,高于两个标准下均为正常血压的人群,HR有统计学意义。结论位于120/80~130/85mmHg区间的107575名人群可能会增加CVD发生风险,仍需密切关注。应基于我国实际人口发展状况,采取高血压防线关口前移策略,通过控制发病率降低实现更加有效的防治。Objective To investigate the association of the blood pressure standard defined by the 2020 International Society of Hypertension(ISH)and the 2017 American College of Cardiology/American Heart Association(ACC/AHA)with the risk of CVD incidence of the Tianjin elderly especially whose blood pressure value is defined as normal blood pressure by 2017 ACC/AHA and high blood pressure value by 2020 ISH.The result of this research will provide the reference for assessing with the application of 2020 ISH for the prevention of CVD.Methods A total of 191043 participants whose age were 60 or above in based of the cohort of health records of Tianjin residents were enrolled stochastically.The diagnosis of blood pressure was based of 2017 ACC/AHA and 2020 ISH respectively.Chi square test,independent sample t-test and Cox proportional hazard model were used.Results Overall,during a mean follow-up of 7 years,the CVD risk with the HR value of 1.248,95%CI:1.187-1.313 of the 51605 objects whose systolic blood pressure(SBP)/diastolic BP(DBP)value was between 120/80 and 130/85mm Hg which is defined as normal blood pressure by 2017 ACC/AHA and high blood pressure value by 2020 ISH increased obviously than the normal value objects both in 2017 ACC/AHA and 2020 ISH.The HR was statistically significant.Conclusions The 107575 people in the 120/80-130/85mm Hg range may increase the risk of CVD.The population in this specific interval still need to be closely watched after the standard for normal blood pressure was expanded by 2020 ISH.We should adopt a strategy of moving forward the threshold of hypertension defense line to achieve more effective prevention and treatment by controlling the incidence of disease based on the actual population development in China.

关 键 词：2020 ISH高血压指南 2017 ACC/AHA高血压指南 高血压 主要心血管事件 

分 类 号：R544[医药卫生—心血管疾病]