中老年自然人群中高血压和亚临床颈动脉粥样硬化的关联研究

目的 研究中国自然人群高血压类型及高血压病程与颈动脉粥样硬化的关联。方法 2002年9月对北京石景山区43～73岁农村居民1198人进行心血管病随访和危险因素横断面调查及颈动脉超声检查。根据“中国高血压防治指南”将人群分为理想血压、正常血压、正常高限血压、1期高血压、2期高血压和3期高血压6组。结果 (1)颈总动脉内中膜厚度(IMT):随着血压水平的升高或高血压病程的延长,IMT呈现明显上升趋势。调整年龄、体重指数、总胆固醇、高密度脂蛋白胆固醇、血糖和是否吸烟,收缩压、舒张压与IMT的回归系数在0.001左右,病程时间与IMT的回归系数为0.002(P<0.01)。调整血压,病程时间与IMT之间的关联失去统计学意义。(2)斑块:检出率随着血压水平升高,或病程时间的延长而增加。调整年龄,与理想血压组相比,2期高血压组男性检出斑块的危险是3.0(95％CI:1.1～8.5),3期高血压女性是7.0(95％CI:2.7～18.3);与无高血压病史者相比,病程在6年以上的男性OR值为2.4(95％CI:1.4～4.2),女性为2.7(95％CI:1.7～4.1)。调整血压类型,6年以上病程的女性OR值为2.1(95％CI:1.1～3.8),其他组均失去统计学意义。结论 高血压是自然人群罹患颈动脉粥样硬化的重要危险因素。维持良好的血压状态可能会对预防动脉粥样硬化发挥重要作用。

Hypertension and subclinical carotid atherosclerosis in a general population of a rural areas in China

Objective To explore the association of hypertension and carotid atherosclerosis in a general population in China. Methods A population-based epidemiological survey on cardiovascular diseases was performed in autumn, 2002. A total of 1198 rural residents with 426 men and 776 women aged 43-73 years, underwent carotid duplex examination. Hypertension was classified into 6 groups of optimal, normal,high-normal,stage 1,2 and 3. Results (1) A significant positive dose-response relation was found between hypertension categories,duration of hypertension and intima-media thickness (IMT) in both genders (trend test P< 0.01). After adjustment of age, body mass index, total cholesterol, high density lipoprotein cholesterol, glucose and smoking, the relation did not change. The associations between duration of hypertension and IMT disappeared after further adjustment with blood pressure. (2) The occurrence of plaque was positively associated with blood pressure groups and duration of hypertension, as well as in the age-adjusted models. The associations between duration of hypertension and plaque weakened or disappeared after further adjustment with systolic blood pressure, diastolic blood pressure or hypertension categories. Conclusion Hypertension was associated with subclinical carotid atherosclerosis. Prolonged course of disease might aggravate the carotid atherosclerosis.