我国成年人单纯性收缩期高血压患病率调查

目的评估我国成年人单纯性收缩期高血压的患病率及其人群分布。方法亚洲国际心血管病合作研究(InterASIA)于2000至2001年进行,应用多阶段抽样方法选择15540名35～74岁成年人为代表性样本,分析单纯性收缩期高血压和其他亚型高血压的患病率。应用标准问卷调查高血压病史及其治疗情况。血压值为休息5min后3次坐位血压测量值的平均值。未接受抗高血压治疗的个体通过以下标准确定高血压亚型单纯性收缩期高血压为收缩压≥140mmHg(1mmHg=0133kPa),舒张期血压<90mmHg;单纯性舒张期高血压为收缩压<140mmHg,舒张压≥90mmHg,而收缩期和舒张期联合性高血压为收缩压≥140mmHg,舒张压≥90mmHg。结果15540名35～74岁成年人样本中,76%(1181人)患有单纯性收缩期高血压,74%(1150人)患有收缩期和舒张期联合性高血压,而44%(683人)患有单纯性舒张期高血压。收缩期高血压的患病率随着年龄的增长而增加,且老年女性比老年男性更为常见。南方与北方地区的单纯性收缩期高血压患病率没有明显差异;农村单纯性收缩期高血压患病率高于城市。结论我国收缩期高血压患病率较高,应引起重视。     

Trandolapril/verapamil combination in hypertensive diabetic patients

Cardiovascular diseases are directly affected by arterial hypertension. When associated with diabetes mellitus, the potential deleterious effects are well amplified. Both conditions play a central role in the pathogenesis of coronary artery disease, heart failure, stroke, and renal insufficiency. Prevalence of hypertension is much higher among diabetic than non-diabetic patients, and the hypertensive patient is more likely to develop type 2 diabetes. Current international guidelines recommend aggressive reductions in blood pressure (BP) in hypertensive patients with additional risk factors, including cardiovascular risk factors, and emphasize the relevance of intensive reduction in patients with diabetes mellitus; a goal of 130/80 mm Hg is required. To achieve BP target a combination of antihypertensives will be needed, and the use of long-acting drugs that are able to provide 24-hour efficacy with a once-daily dosing confers the noteworthy advantages of compliance improvement and BP variation lessening. Lower dosages of the individual treatments of the combination therapy can be administered for the same antihypertensive efficiency as that attained with high dosages of monotherapy. Angiotensin-converting enzyme inhibitors and calcium-channel blockers as a combination have theoretically compelling advantages for vessel homeostasis. Trandolapril/verapamil sustained release combination has showed beneficial effects on cardiac and renal systems as well as its antihypertensive efficacy, with no metabolic disturbances. This combination can be considered as an effective therapy for the diabetic hypertensive population.     

Multiple risk factor intervention trial (MRFIT).: VI. Intervention on blood pressure

The MRFIT blood pressure data derived from the Special Intervention (SI) group of men over the first 4 years are presented, and the results of the hypertension treatment program are reviewed. A therapeutic goal diastolic blood pressure (DBP) was established for each man determined to be hypertensive which included men with DBP ?90 mm Hg and men who were already taking antihypertensive drugs. A stepped care protocol was used to guide the drug treatment. At the fourth annual examination, 63.8% of the 5,790 SI men seen had been previously declared hypertensive. The mean baseline blood pressure (BP) for the hypertensive group was 140.3 mm Hg, systolic, and 94.5 mm Hg, diastolic, and at the 48-month visit, the mean BP was 120.7 mm Hg, systolic, and 82.5 mm Hg, diastolic. Of the hypertensive men seen at 48 months, 87.3% were taking antihypertensive drugs, 65.4% were at or below their goal pressure, and 83.5% had a DBP <90 mm Hg. Most men on antihypertensive drug therapy were at protocol Step 1 or Step 2, receiving a diuretic agent alone (32.9%), or in combination with an antiadrenergic drug (40.4%). Data for specific drug regimens are presented. Older men and men with higher BP levels at entry had a better response. The MRFIT BP results, achieved within a context of a multiple-risk-factor intervention program, compare favorably with the results from recently reported trials that focused solely on the treatment of mild hypertension.     

The costs of treating hypertension--an analysis of different cut-off points

In this article the effects of different cut-off points for hypertension treatment are analysed, with respect to treatment costs. A theoretical blood pressure distribution is used to calculate the potential annual cost of treating all persons in Sweden above certain cut-off points for drug treatment. A lowering of the cut-off point from 105 mm Hg to 100 mm Hg diastolic blood pressure could potentially lead to an increase in annual costs of approximately 80m pounds. Further lowering from 100 to 95 mm Hg in turn could increase annual costs by about 110m pounds. The potential annual cost of treating all persons (roughly 1.6 million) with a diastolic blood pressure of greater than or equal to 95 mm Hg with drugs is calculated as being roughly 40 pounds per inhabitant in Sweden. The Swedish cut-off point for treatment (95 mm Hg) can be expected to lead to roughly 50 per cent higher treatment costs than the British cut-off point (100 mm Hg).     

Management of Hypertension in Patients with Diabetes Mellitus

Hypertension and diabetes mellitus are significant and independent risk factors for cardiovascular disease.Antihypertensive therapy reduces cerebrovascular and cardiovascular morbidity and mortality in patients with hypertension. Tight blood pressure (BP) control [target diastolic BP (DBP) ≤80mm Hg] reduced the incidence of major cardiovascular events by 51% compared with less tight control (DBP ≤90mm Hg) in patients with diabetes mellitus in the Hypertension Optimal Treatment (HOT) study. Similarly, in the UK Prospective Diabetes Study (UKPDS), tight BP control [mean systolic BP (SBP)/DBP = 144/82mm Hg] with captopril or atenolol reduced diabetes mellitus-related morbidity and mortality by 24% compared with less tight control (mean SBP/DBP = 154/87mm Hg). Importantly, the frequency of microvascular disease (including retinopathy) was reduced by 37% among those randomised to tight BP control in the UKPDS.In the diabetic subgroup in the Heart Outcomes Prevention Evaluation (HOPE) study, there was a 25% reduction in the composite end-point of death due to cardiovascular causes, or myocardial infarction or stroke during 5 years of treatment with ramipril 10 mg/day relative to placebo.Lisinopril is an ACE inhibitor indicated for use in hypertension, heart failure and post-myocardial infarction. As an antihypertensive agent the drug is effective and generally well tolerated in patients with type 1 or 2 diabetes mellitus and in those with early or overt nephropathy.In the Swedish Treatment of Old People (STOP) Hypertension 2 trial, there was no difference in the relative risk of cardiovascular death between those assigned to ACE inhibitors (lisinopril or enalapril), calcium channel blockers (felodipine or isradipine) or ‘conventional’ antihypertensive therapy (thiazide diuretics or β blockers); treatment effects did not differ significantly between diabetic and nondiabetic patients (10.9% of the 6614 patients had diabetes mellitus). Importantly, lower frequencies of nonfatal or fatal myocardial infarction [relative risk (RR) 0.77; 95% confidence interval (CI) 0.61 to 0.96] and congestive heart failure (RR 0.78; CI 0.83 to 0.97) were detected during 4 years’ treatment with lisinopril or enalapril than felodipine or isradipine in this study.Lisinopril reduced albumin excretion rates in patients with type 1 or 2 diabetes mellitus. In the 2-year EURODIAB Controlled Trial of Lisinopril in IDDM (EUCLID) study, albumin excretion rates decreased by 49.7% relative to placebo in normotensive patients with type 1 diabetes mellitus and microalbuminuria during treatment with lisinopril 10 to 20 mg/day. Progression of retinopathy was attenuated in normotensive patients with type 1 diabetes mellitus during treatment with lisinopril in this study.In conclusion, lisinopril, like other ACE inhibitors should be considered a first-line agent for reducing BP and attenuating nephropathy in patients with type 1 or 2 diabetes mellitus.     

Glucose, insulin, and incident hypertension in the multi-ethnic study of atherosclerosis

Diabetes mellitus and hypertension commonly coexist, but the nature of this link is not well understood. The authors tested whether diabetes and higher concentrations of fasting serum glucose and insulin are associated with increased risk of developing incident hypertension in the community-based Multi-Ethnic Study of Atherosclerosis. At baseline, 3,513 participants were free of hypertension, defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive medications to treat high blood pressure. Of these, 965 participants (27%) developed incident hypertension over 4.7 years' median follow-up between 2002 and 2007. Compared with participants with normal baseline fasting glucose, those with impaired fasting glucose and diabetes had adjusted relative risks of hypertension of 1.16 (95% confidence interval (CI): 0.96, 1.40) and 1.41 (95% CI: 1.17, 1.71), respectively (P = 0.0015). The adjusted relative risk of incident hypertension was 1.08 (95% CI: 1.04, 1.13) for each mmol/L higher glucose (P < 0.0001) and 1.15 (95% CI: 1.05, 1.25) for each doubling of insulin (P = 0.0016). Further adjustment for serum cystatin C, urinary albumin/creatinine ratio, and arterial elasticity measured by tonometry substantially reduced the magnitudes of these associations. In conclusion, diabetes and higher concentrations of glucose and insulin may contribute to the development of hypertension, in part through kidney disease and arterial stiffness.     

Case in Point

Abstract

Epidemiologic and clinical trial data suggest that blood pressure in patients with hypertension who are at high risk for cardiovascular events because of coronary artery disease, diabetes, chronic kidney disease, stroke, or heart failure should be reduced to < 140/90 mm Hg in patients aged < 80 years, and that systolic blood pressure should be reduced to 140 to 145 mm Hg, if tolerated, in patients aged ≥ 80 years. Studies on patients with coronary artery disease, diabetes, chronic kidney disease, stroke, and heart failure are discussed, supporting a blood pressure goal of < 140/90 mm Hg in patients aged < 80 years who are at high risk for cardiovascular events.     

Financial cost as an obstacle to hypertension therapy.

A home health interview, including blood pressure measurements, was conducted on 4,688 adults representing the noninstitutionalized population of Georgia. Subjects with diastolic blood pressure greater than or equal to 90 mm Hg or on antihypertensive medication were considered hypertensive. The prevalence of uncontrolled moderate or severe hypertension (diastolic greater than or equal to 105 mm Hg) was 1.9 per cent. With the exception of White women, all race-sex groups with uncontrolled moderate or severe hypertension reported substantially lower per capita income than their mild or controlled hypertensive counterparts. A larger percentage of the uncontrolled moderate to severe hypertensives on medication, as compared to their mild or controlled counterparts, reported economic barriers to pharmacologic and medical care on cost of medicines (36 per cent vs 22 per cent); refills (36 per cent vs 16 per cent); and office visits (26 per cent vs 16 per cent). Black women reported these barriers more than Whites. These findings suggest that costs of antihypertensive care may be an obstacle in blood pressure control for certain population subgroups.     

温州市瓯海区居民高血压患病率及影响因素分析

目的了解温州市瓯海区居民高血压流行病学状况。方法采用整群随机抽样的方法抽取2个村1872名18岁以上的常住居民,于2008年进行问卷调查、体格检查和实验室检测。结果调查人群平均收缩压为（129．3±19．8）mmHg,平均舒张压为（81．3±9．8）mmHg。高血压患病粗率为36．6％,标化患病率为24．3％,男性为26．9％,女性为21．6％。高血压人群知晓率为53．2％,服药率为43．4％,控制率仅为9．2％。在血压正常人群中,仅36．4％的人血压处于120／80mmHg（收缩压／舒张压）以下,有63．6％的人血压处于正常高值。高血压人群患糖尿病、高尿酸血症、血脂异常、超重和肥胖、代谢综合征的比例高于血压正常人群。Logistic多因素回归分析显示,高血压家族史、糖尿病、高TG血症、超重和肥胖、经常饮酒、腰围和年龄大是高血压患病的危险因素,而文化程度高是保护因素。结论温州市瓯海区居民高血压患病率与1991年相比明显增长（近1倍）,而知晓率、服药率和控制率仍偏低。     

Studies in hypertension: implications for clinical medicine

Population studies that demonstrated risk from elevation of blood pressure were a necessary foundation for a sound clinical approach to hypertension. Clinical trials then demonstrated that lowering pressure with drug therapy dramatically reduced risk of cardiovascular catastrophes, including death. The U.S. Veterans Administration (VA) study proved the need to treat moderate and severe hypertension, but left unproven the benefit for so-called mild hypertension (diastolic blood pressure 90–104 mm Hg). The Hypertension Detection and Follow-up Program (HDFP) investigated applicability of VA findings to the “average” hypertensive, particularly to the majority in the range 90–104 mm Hg. Two randomly constituted groups, Stepped Care (SC) and Referred Care (RC), included 10,940 hypertensives, age 30–69, identified in population-based screening in 14 communities, and followed for 5 years. Almost $\text{3}\text{4}$ (71%) were so-called mild hypertensives. SC patients were treated vigorously in special clinical centers to lower pressure to a diastolic goal no higher than 80–90 mm Hg (depending on entry level), starting with low dose diuretics and adding medication stepwise as needed, until the goal was reached. RC patients were treated by usual sources of medical care. A larger proportion of SC than RC patients were on therapy and at the goal each year of the study. The fifth year diastolic average was 84 mm Hg in SC and 89 mm Hg in RC. The 5-year all causes mortality rate was 17% lower in SC than RC. In the mild hypertension stratum, this difference was 20%. Clinical implications from the HDFP trial include demonstration of: the validity of the VA findings on the benefit of treating moderate and severe hypertension; the benefit of treatment also for those with sustained average diastolic pressures 90–104 mm Hg; the utility of lowering pressure before target organ damage; the utility of stepwise drug treatment to a normotensive goal; the ability to achieve long-term patient adherence; the contribution of nonphysician personnel in helping achieve these aims. The possible role of non-pharmacologic measures was not tested in these trials and remains an important question in determining best methods for control of hypertension.     

Pet ownership and blood pressure in old age

BACKGROUND: It has been proposed that pet ownership improves cardiovascular health. This study examines the relation of pet ownership with systolic and diastolic blood pressure, pulse pressure, mean arterial pressure, and hypertension in a large sample of older men and women. METHODS: Participants were 1179 community-dwelling men (n = 498) and women (n = 681) age 50-95 years. Participants responded to a 1991-1992 mailed questionnaire ascertaining pet ownership, and they attended a 1992-1996 clinic visit at which systolic (SBP) and diastolic (DBP) blood pressures were measured and use of antihypertensive medication was validated. Pulse pressure was calculated as SBP minus DBP. Mean arterial pressure was calculated as (SBP+DBP)/2. Body mass index, waist-hip ratio, and information on other potential confounders were obtained. RESULTS: Average age of participants was 70.4 +/- 10.8 years; 30.0% reported current pet ownership. Mean SBP was 137.5 +/- 21.4 mm Hg, and DBP was 76.1 +/- 9.3 mm Hg; 55.6% were hypertensive (SBP >or= 140, DBP >or= 90 or taking hypertension medication). Pet owners were younger and slightly more overweight and they exercised less than nonowners; owners were somewhat more likely to have diabetes and to use beta-blockers. In unadjusted analyses, pet owners had lower SBP, pulse pressure, and mean arterial pressure, and a reduced risk of hypertension (odds ratio = 0.62; 95% confidence interval = 0.49-0.80). However, after adjustment for age and other confounders, pet ownership was not associated with systolic or diastolic blood pressure, pulse pressure, mean arterial pressure or risk of hypertension. CONCLUSIONS: Results suggest that pet ownership is not independently associated with blood pressure, vascular reactivity, or hypertension.     

Treatment of hypertension at an outpatient hypertension clinic. Blood pressure control, dropout rate, and side effects

Long-term results from an outpatient hypertension clinic concerning blood pressure (BP) control, dropout rate, and adverse effects of treatment in a random population sample are presented. Six hundred eighty-six men, aged 47–54 years, and recruited from a screening examination with casual systolic BP > 175 mm Hg or diastolic BP > 115 mm Hg on two occasions or already on antihypertensive therapy, were treated and followed for 5 years. The 5-year dropout rate of patients refusing to participate or lost for unknown reasons was low (4.2%), with the highest incidence during the first year (2.2%). The most commonly used drugs were beta-adrenoceptor blocking agents (69%), thiazide diuretics (62%), and hydralazine (34%). After 5 years' follow-up 58% of the patients had BP below 160 mm Hg systolic and 95 mm Hg diastolic, 33% had BP between 160–170 mm Hg systolic or 95–105 mm Hg diastolic, and 9% remained above 170 mm Hg systolic and/or 105 mm Hg diastolic. This blood pressure control was in many cases achieved first after several years of treatment and with the frequent use of combination drug therapy (66%). Patients who remained above 170 mm Hg systolic and/or 105 mm Hg diastolic after 5 years were characterized by higher initial BPs, more frequent eye—ground changes, heart enlargement, and more frequent alcohol problems, but also by being on more aggressive treatment. After the initial treatment phase, the frequency of adverse effects necessitating drug withdrawal was low, approximately 3% per year. These promising results are attributed to the clinical routine used and thus point to a potential benefit of structured care for the management of large patient populations.     

老年高血压患者血压控制不佳与认知相关因素调查

目的探讨老年高血压控制不佳的相关因素。方法对862例高血压患者问卷调查血压控制情况与认知相关因素。结果本组平均血压值为（142.7±12.0）/（81.5±9.4）mmHg,收缩压和舒张压控制理想分别为47.3%和71.6%。文盲及小学文化患者的药物错服率明显高于初中、高中和大学组（P〈0.05）;11.6%的病例不能遵医嘱服用降压药物;10.8%患者不能回答出最新高血压的诊断标准;3.8%的患者不知道降压药物需要持续服用。结论老年高血压患者对高血压病及降压治疗的认知程度较低,总体血压控制不佳,应加强高血压知识的宣教和指导。     

北京市社区老年人群血压水平与认知功能变化的4年纵向研究

目的 探讨北京市社区老年人血压与通过简短精神状态(MMSE)量表检测的认知功能之间的关系。方法 以北京市一个有代表性的60岁及以上老年群体为研究对象,进行大样本的纵向流行病学研究。于1993年进行基线调查,检测血压,以MMSE为工具检查认知功能,并进行问卷调查,内容包括人口学情况、健康状况、生活状况等。1997年进行随访,以相同的工具复测认知功能并进行问卷调查,分析基线认知功能正常者4年后的变化。结果 2079名基线认知得分正常的老年人,平均收缩压为(141.77±24.94)mmHg(1mmHg=0.133kPa),平均舒张压为(81.76±12.08)mmHg。基线平均MMSE得分(25.65±3.59)分,4年后随访平均MMSE得分(23.24±5.63)分。随访得分与基线得分比较下降≥4分为认知功能明显下降。发现随着基线收缩压及舒张压水平增高,认知得分及认知功能明显下降的老年人比例增大。分层分析提示,在低龄(<75岁)、农村、无糖尿病及不用降压药物的老年人中,不同血压水平对认知功能改变有显著影响,血压水平高者认知得分明显下降的比例增大,这种关系在排除脑血管病和心脏病的影响后,在收缩压组依然存在。结论 纵向研究显示,老年人收缩压及舒张压升高可导致认知功能受损,随着血压水平的增高,认知功能下降的幅度增大。     

Evaluation of a decentralized system for chronic disease care: seven years of observation.

Observations of a publicly-financed system for the medical care of a large number of persons with chronic diseases have been made over seven years. The system combines decentralized, nurse-staffed neighborhood clinics, operated by a public health department, with a central referral clinic for consultations and the management of complicated problems. After seven years in the chronic disease program 55% of 1,004 patients with diagnoses of diabetes mellitus, hypertension, and cardiac diseases were still receiving care, 19% had died, and 26% had been lost to the program. In the seventh year, the mean diastolic blood pressure in hypertensives was 84 mm Hg and the mean serum glucose in diabetics was 203 mg/dl. For the group under care, hospital days/1000/year were 74% of the rate during the year before referral to the program and out-patient visits/1000/year were approximately the same as before referral. However, two-thirds of the visits, formerly made to a public hospital, were now being made to neighborhood clinics. The system appears to be an effective method of providing medical services for persons who formerly used the public hospital as their source of outpatient care.     

Management of Neurogenic Orthostatic Hypotension

The burden of orthostatic hypotension (OH) on public health is a universally recognized enigmatic clinical condition that is associated with significant increases on morbidity and mortality rates, and can take a major toll on one's quality of life. Orthostatic hypotension is predictive of vascular deaths from acute myocardial infarction, strokes in the middle aged population, and increases mortality rates when associated with diabetes, hypertension, Parkinson's disease, and patients receiving renal dialysis. The consensus definition for OH is a fall in systolic blood pressure of at least 20 mm Hg and/or diastolic blood pressure of at least 10 mm Hg within 3 minutes of quiet standing. Because neurogenic OH is often accompanied by supine hypertension, the treatment program should aim toward minimizing OH and the potential fall injuries related to cerebral hypoperfusion without exacerbating nocturnal hypertension that may lead to excessive cardiovascular complications.     

Integration of depression and hypertension treatment: a pilot, randomized controlled trial

PURPOSE We wanted to examine whether integrating depression treatment into care for hypertension improved adherence to antidepressant and antihypertensive medications, depression outcomes, and blood pressure control among older primary care patients.METHODS Older adults prescribed pharmacotherapy for depression and hypertension from physicians at a large primary care practice in West Philadelphia were randomly assigned to an integrated care intervention or usual care. Outcomes were assessed at baseline, 2, 4, and 6 weeks using the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depression, an electronic monitor to measure blood pressure, and the Medication Event Monitoring System to assess adherence.RESULTS In all, 64 participants aged 50 to 80 years participated. Participants in the integrated care intervention had fewer depressive symptoms (CES-D mean scores, intervention 9.9 vs usual care 19.3; P <.01), lower systolic blood pressure (intervention 127.3 mm Hg vs usual care 141.3 mm Hg; P <.01), and lower diastolic blood pressure (intervention 75.8 mm Hg vs usual care 85.0 mm Hg; P <.01) compared with participants in the usual care group at 6 weeks. Compared with the usual care group, the proportion of participants in the intervention group who had 80% or greater adherence to an antidepressant medication (intervention 71.9% vs usual care 31.3%; P <.01) and to an antihypertensive medication (intervention 78.1% vs usual care 31.3%; P <.001) was greater at 6 weeks.CONCLUSION A pilot, randomized controlled trial integrating depression and hypertension treatment was successful in improving patient outcomes. Integrated interventions may be more feasible and effective in real-world practices, where there are competing demands for limited resources.     

Incidental blood pressure elevations: a MIRNET project

BACKGROUND. A prospective study was undertaken to determine the prevalence of hypertension in office patients with an incidental diastolic blood pressure greater than or equal to 90 mm Hg. METHODS. During routine screening of 14,890 patients, 174 patients with elevated diastolic blood pressures but no previous diagnosis of hypertension were identified over a 3-month period. Only 115 (64%) returned as requested for two subsequent blood pressure readings. RESULTS. Sixty percent of those returning fit the definition for hypertension using the criteria of the Joint National Committee on Detection, Evaluation, and Treatment of Hypertension. Sixty-nine percent (43/62) of the men and 49% (26/53) of the women were hypertensive. Women under 40 years old were less likely to be hypertensive, but age did not predict hypertension in men. Among those patients with a diastolic pressure reading below 105 mm Hg, progressively higher diastolic readings on the first visit did not predict a higher probability of hypertension. Among those patients with a diastolic pressure reading above 105 mm Hg, however, 90% (9/10) were hypertensive. CONCLUSIONS. Physicians should take incidental elevation of diastolic pressure seriously because of the high prevalence of confirmed hypertension in this group of patients.     

太原市四社区高血压两类降压药物规范治疗低危患者疗效分析

目的为正确评价社区高血压规范化管理中钙拮抗剂和复方制剂治疗高血压低危患者的疗效。方法随访监测太原市四社区接受钙拮抗剂和复方制剂类药物患者各60例,编程在SAS PROC MIXED过程中实现。结果太原市山毛社区血压估计值为80.493 3mm Hg,平阳社区80.503 3mm Hg,双塔中心77.143 3mm Hg,厂矿社区73.620 0mm Hg,4个社区血压值差异有统计学意义（P〈0.05）。钙拮抗剂组较复方制剂组血压值高1.22mm Hg,尚不能认为两药物组血压值差异有统计学意义（P=0.152 7）。治疗后患者血压值均随时间有明显下降（P〈0.05）。收缩压在治疗3个月下降6.65mm Hg,治疗6个月下降1.816 7mm Hg,治疗9个月下降0.366 7mm Hg。舒张压在治疗3个月下降4.241 7mm Hg,治疗6个月、9个月分别下降1.375 0mm Hg、0.483 3mm Hg。结论钙拮抗剂和复方制剂都是社区规范化管理中低危患者控制血压安全有效的药物。     

中老年人血压水平与脑卒中患病率及患病风险的相关性研究

目的 研究中老年人群中血压水平与脑卒中患病率及患病风险之间的关系。方法 采用分层整群抽样方法,对扬州市广陵区40岁及以上常住居民开展问卷调查、体格检查和实验室检查。通过对年龄分层,采用单因素和多因素logistic回归分析不同年龄组血压与脑卒中患病率及患病风险的关系。结果 3 999例有效样本中,男性1 904例（47.61%）,女性2 095例（52.39%）;其中脑卒中243例（6.08%）,高血压1 900例（47.51%）,糖尿病929例（23.23%）,血脂异常943例（23.58%）,高血压患者中脑卒中211例（86.83%）。男性（χ2 = 9.539,P = 0.002）、高龄（t = - 13.683,P＜0.001）、缺乏运动（χ2 = 15.568,P＜0.001）、吸烟史（χ2 = 40.799,P＜0.001）、高血压（t = - 9.149,P＜0.001）、高血糖（t = - 6.832,P＜0.001）、低高密度脂蛋白胆固醇（t = 3.509,P＜0.001）、肥胖（t = - 4.964,P＜0.001）均是脑卒中重要危险因素。随着年龄和血压的增加,脑卒中的患病率增加。对年龄进行分层,并对危险因素进行校正,60岁以下人群中脑卒中患病风险随血压升高而显著增加;收缩压≥160 mm Hg脑卒中患病风险是收缩压＜130 mm Hg的8.13倍;舒张压≥110 mm Hg脑卒中患病风险是舒张压＜80 mm Hg的28.54倍。60岁及以上人群中收缩压≥150 mm Hg脑卒中患病风险开始增加;收缩压≥160 mm Hg脑卒中患病风险是收缩压＜130 mm Hg的2.12倍;舒张压与脑卒中患病风险之间无显著相关性。结论 高血压是脑卒中的重要危险因素,根据不同的年龄,设定相应的降压目标是有效预防脑卒中的重要途径。