单纯舒张期高血压预后的前瞻性研究

目的 :探讨单纯舒张期高血压 (IDH)对心血管事件 (CVD)发生的危险性。方法 :采用前瞻队列研究方法 ,对北京市自然人群 (40岁以上 )共 7333人于 1991年基线危险因素调查后 ,分别于 1996年、1999年二次进行随访。对在随访期间发生的心血管事件和死亡进行登记。并根据基线调查时收缩压及舒张压水平 ,将队列人群分成以下 4组 :正常血压组 ,单纯舒张期高血压组 ,单纯收缩期高血压组 ,收缩压合并舒张压升高组。不同血压组与CVD事件发生率之间的关系分别进行单因素分析 (Gehan检验 )及多因素分析 (Cox回归 )。结果 :1 单纯舒张期高血压组平均年龄最小 (5 2 1± 8 7岁 ) ,其在中年人中占较大的比例 (82 8% ) ,而单纯收缩期高血压组平均年龄最大 (6 4 3± 9 8岁 ) ,其在老年人中占较大构成比 (6 5 9% )。 2 与正常血压组相比 ,单纯舒张期高血压组发生心血管事件的危险性无显著性差异(RR =1 0 9,95 %CI:0 5 6～ 2 .13) ,而单纯收缩期高血压组及收缩压合并舒张压升高组的危险性显著升高 ,RR分别为 :2 0 3(95 %CI:1 6 3～ 2 .5 2 )、3 38(95 %CI:2 73～ 4 .17)。结论 :1 单纯舒张期高血压预后良好 ,而单纯收缩期高血压及收缩压合并舒张压升高者有较大的发生CVD事件的危险性。 2 对高血压患者 ,应着重对升高

A prospective cohort study on the prognosis of isolated diastolic hypertension(IDH)

Objective:To explore the risk of isolated diastolic hypertension(IDH)to the cardiovascular disease(CVD).Method:A prospective cohort study was carried out in a natural population(aged 40 and over),totally 7,333 subjects.After a baseline survey for risk factors in 1991,follow|up for each subject was done from September 1991 through December 1999.Based on the baseline systolic and diastolic blood pressure levels,the cohort subjects were classified into the following 4 groups:normotension(NT),isolated diastolic hypertension(IDH),isolated systolic hypertension(ISH) and systolic|diasolic hypertension(SDH).The prognostic significance of each type of hypertension for the risk of CVD was investigated by using a Gehan test and a Cox proportional hazards regression model after adjusting for possible confounding factors.Result:(1)The subjects with IDH were the youngest among the 4 groups,whereas those with ISH were oldest.In terms of IDH,the middle|aged subjects accounted for the biggest proportion(82.8%).In contrast,there was a higher proportion of ISH in elderly people.(2)The risks for ISH and IDH were significantly higher than the relative hazard for normotension,with the relative risk(RR)being 2.03(95% confidence interval:1.63～2.52)and 3 38(95% confidence interval:2.73～4.17),respectively,while IDH was associated with no significant increase in risk(RR:1.09,95%CI:0.56～2.13).Conclusion:(1)IDH carried a low risk of CVD,similar to that found in subjects with NT,suggesting that the prognosis of IDH was good.In contrast,both IDH and SDH conferred a higher risk of CVD.(2)SBP was a stronger predictor of CVD compared with DBP,so more attention should be given to SBP during the course of hypertension intervention.