中国35～64岁人群血压水平与10年心血管病发病危险的前瞻性研究

目的探讨我国35～64岁人群血压水平与心血管病发病危险的关系，为《中国高血压防治指南》的修订工作提供流行病学数据。方法采用前瞻性队列研究的方法，对1992年建立的11省市35～64岁队列人群共31728人的基线血压水平和1992～2002年发生的心血管病(包括冠心病和脑卒中)事件的关系进行分析。结果(1)以血压110～119／75～79mmHg(1mmHg=0．133kPa)为对照，血压在120～129／80～84mmHg时，心血管病发病危险增加了1倍(RR=2．09)；血压在140～149／90～94mmHg时，心血管病发病危险增加了2倍以上(RR=3．23)；当血压≥180／110mmHg时，心血管病发病危险增加了10倍以上(RR=11．81)。(2)与理想血压相比，2级高血压时，急性冠心病事件发病的危险是理想血压组的2．3倍，急性缺血性脑卒中和急性出血性脑卒中发病的危险分别是理想血压组的4．9倍和11．7倍。(3)在总的心血管病事件中，36．1％可归因于高血压；其中44．0％的急性脑卒中事件和23．7％的急性冠心病事件可归因于高血压。(4)不同血压水平时，随着合并其他心血管病危险因素个数的增加，10年心血管病发病的综合危险增加。结论血压水平从110／75mm Hg开始，随着血压水平的增加，心血管病发病危险持续上升，所以将某个血压水平作为高血压的诊断标准是人为制订的。应该加强多重危险因素的综合干预，以减少总的心血管病的发病危险。

A prospective study of relationship between blood pressure and 10-year cardiovascular risk in a Chinese cohort aged 35-64 years

OBJECTIVE: To provide epidemiological data for the revision of The National Guideline for Prevention and Treatment of Hypertension through the analysis of the association between blood pressure (BP) and the risk of cardiovascular diseases (CVD) in a cohort aged 35-64 years. METHODS: A prospective study was carried out in 11 provinces from 1992 to 2002. The association between BP and CVD (CHD and stroke) was analyzed in 31728 subjects aged 35 - 64 years. RESULTS: (1) Compared with BP < 110/75 mmHg, the risk of CVD increased 1 time (RR=2.09), 2 times (RR=3.23), and 10 times (RR=11.81) when BP was 120-129/80-84 mmHg, 140-149/90-94 mmHg, and > or = 180/110 mm Hg, respectively. (2) The risk of acute CHD for subjects with stage 2 hypertension was 2.3 times of those with optimal BP, whereas the risk of ischemic stroke and hemorrhagic stroke was 4.9 times and 11.7 times, respectively. (3) 36.1% of all CVDs, 44.0% of the acute stroke and 23.7% of the acute CHD were attributable to hypertension. (4) In each BP level, the 10-year risk of CVD increased with the increased number of other risk factors. CONCLUSIONS: The risk of CVD increases with BP continuously from BP of 110/75 mmHg. Therefore, the cutpoint of the diagnostic criteria for hypertension is arbitrary. Comprehensive intervention for multiple risk factor clustering should be strengthened to reduce the overall risk of CVD.