中国成年高血压患者达到强化收缩压控制目标与心脑血管疾病发生风险的关联研究

杨海铭; 赵禹碹; 吕筠; 余灿清; 郭彧; 裴培; 杜怀东; 陈君石; 陈铮鸣; 孙点剑一; 李立明; 代表中国慢性病前瞻性研究项目协作组

Abstract

杨海铭,赵禹碹,吕筠,余灿清,郭彧,裴培,杜怀东,陈君石,陈铮鸣,孙点剑一,李立明,代表中国慢性病前瞻性研究项目协作组.中国成年高血压患者达到强化收缩压控制目标与心脑血管疾病发生风险的关联研究[J].Chinese journal of Epidemiology,2023,44(8):1175-1182

中国成年高血压患者达到强化收缩压控制目标与心脑血管疾病发生风险的关联研究

Study on the associations of meeting intensive systolic blood pressure control goals with risk for incident cardiovascular and cerebrovascular diseases among the adult hypertensive patients in China

Received:March 17, 2023

DOI：10.3760/cma.j.cn112338-20230317-00156

KeyWord: 高血压心脑血管疾病强化收缩压控制

English Key Word: Hypertension Cardiovascular and cerebrovascular diseases Intensive systolic blood pressure control

FundProject:国家自然科学基金（82103920，82192904，82192901，82192900，81941018）；国家重点研发计划（2020YFC2003405）；国家重点研发计划“精准医学研究”重点专项（2016YFC0900500）；中国香港Kadoorie Charitable基金

Author Name	Affiliation	E-mail
Yang Haiming	Key Laboratory of Epidemiology of Major Diseases, Ministry of Education/Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Zhao Yuxuan	Key Laboratory of Epidemiology of Major Diseases, Ministry of Education/Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Lyu Jun	Key Laboratory of Epidemiology of Major Diseases, Ministry of Education/Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
Yu Canqing	Key Laboratory of Epidemiology of Major Diseases, Ministry of Education/Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
Guo Yu	Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
Pei Pei	Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
Du Huaidong	Medical Research Council Population Health Research Unit at the University of Oxford, Oxford OX3 7LF, United Kingdom Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
Chen Junshi	China National Center for Food Safety Risk Assessment, Beijing 100022, China
Chen Zhengming	Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
Sun Dianjianyi	Key Laboratory of Epidemiology of Major Diseases, Ministry of Education/Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China	dsun1@bjmu.edu.cn
Li Liming	Key Laboratory of Epidemiology of Major Diseases, Ministry of Education/Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
for the China Kadoorie Biobank Collaborative Group

Hits: 3440

Download times: 1001

Abstract:

目的在中国成年高血压人群中,分析达到强化收缩压(SBP)控制目标(≤ 130 mmHg)与新发心脑血管疾病风险的关联。方法本研究基于中国慢性病前瞻性研究中成年高血压患者数据。采用logistic回归模型分析达到强化和常规SBP控制目标的影响因素,采用Cox比例风险回归模型分析达到强化和常规SBP控制目标与发生心脑血管疾病风险的关联。结果共纳入3 628名自报连续服药控制血压的参与者,其中5.0%达到了强化SBP控制目标。在调整性别、年龄以及城乡后,文化程度大专及以上(OR=2.36,95%CI:1.32~4.04)、坚持健康膳食(OR=2.09,95%CI:1.45~2.96)、每日摄入新鲜水果(OR=1.67,95%CI:1.17~2.36)以及采用联合用药(OR=1.82,95%CI:1.03~3.09)的患者更容易达到强化SBP控制目标。随访(10.0±3.7)年后,复合心脑血管结局发生1 278名。本研究未观察到达到强化SBP控制目标与常规目标者发生复合心脑血管结局风险差异有统计学意义(HR=0.89,95%CI:0.63~1.25)。主要心血管不良事件、脑血管疾病、脑卒中和缺血性脑卒中发生风险随SBP控制水平的增强有降低的趋势(趋势检验P<0.05)。结论本研究观察到主要心血管不良事件和脑血管疾病发生风险随SBP控制水平增强而降低的趋势,但未观察到达到强化SBP控制目标相比于常规控制目标对心脑血管疾病的显著保护作用。

English Abstract:

Objective To evaluate the associations of meeting intensive systolic blood pressure (SBP) control goals with risk for incident cardiovascular and cerebrovascular diseases among the adult hypertensive patients in China. Methods We used data from adult hypertensive patients from the China Kadoorie Biobank. logistic regression models evaluated the influencing factors of meeting intensive and standard SBP control goals. Cox proportional hazard models evaluated the associations between meeting intensive vs. standard SBP control goals and risk for incident cardiovascular and cerebrovascular diseases. Results A total of 3 628 hypertensive patients who reported continuous medication use were included in this study, of which 5.0% of the participants met the goals of intensive SBP control (≤ 130 mmHg). Participants with higher educational attainment (OR=2.36,95%CI:1.32-4.04), healthier diet (OR=2.09,95%CI:1.45-2.96), daily intake of fresh fruit (OR=1.67,95%CI: 1.17-2.36) and combination treatment (OR=1.82,95%CI:1.03-3.09) were more likely to meet intensive SBP control goal after adjustment of age, sex and urban/rural areas. During an average follow-up of (10.0±3.7) years, 1 278 cases of composite cardiovascular outcome were recorded. This study did not find a statistical correlation between achieving the goal of enhanced SBP control and the occurrence of composite cardiovascular and cerebrovascular outcomes (HR=0.89, 95%CI:0.63-1.25). For major adverse cardiovascular events (MACE), cerebrovascular diseases, stroke, and ischemic stroke, we observed a trend of decrease in risk of outcomes with more intensive SBP control (trend test P<0.05). Conclusions We observed decreased risk for MACE and cerebrovascular diseases with more intensive SBP control. However, there was no significant risk reduction for cardiovascular and cerebrovascular diseases when meeting the intensive SBP control goal, compared to the standard SBP control goal.

View Fulltext Html FullText View/Add Comment Download reader