Real-world evidence of the association between blood pressure elevation and coronary artery disease and stroke in Japan
Real-world evidence of the association between blood pressure elevation and coronary artery disease and stroke in Japan
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日本血压升高与冠状动脉疾病和中风之间关联的真实世界证据
DOI：
10.1038/s41440-022-01156-z
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发表时间：
2023
影响因子：
5.4
通讯作者：
Kai H
中科院分区：
文献类型：
--
作者：
Oda S;Nakaura T;Utsunomiya D;Hirakawa K;Takashio S;Izumiya Y;Tsujita K;Kawano Y;Okuno Y;Hata H;Matsuoka M;Yamashita T;Ueda M;Ando Y;Yamashita Y.;Kai H
大脑和心脏以及肾脏是高血压的主要靶器官。一项对61项关于血压(BP)和死亡率的前瞻性观察研究(包括958,074名既往没有心血管疾病的成年人)进行的大规模荟萃分析表明，冠状动脉疾病(CAD)和中风的死亡率随着收缩压(SBP)和舒张压(DBP)水平的升高呈指数级增加，而没有任何证据表明阈值至少降至115/75毫米汞[1]。此外，对于年龄在50岁到89岁之间的人群，无论性别，也显示出类似的关联。Epoch-Japan是对10项队列研究的荟萃分析，该研究涵盖了日本约70,000人，结果表明，收缩压/舒张压水平与心血管疾病死亡率之间几乎呈对数线性关系，在中年(40-年龄组)和老年(65-74岁)年龄组中，血压水平为120/80毫米汞柱的个人风险最低[2]。最近，Yamada et al.通过分析来自全国基于索赔的数据库的数据，调查了BP与根据血糖状况的冠心病或中风发病率之间的关系，该数据库包括在日本公司员工及其家属的健康保险提供商登记的805992名既往没有心血管疾病的成年人的信息[3]。他们发现，无论血糖水平异常的存在或严重程度如何，SBP和DBP与CAD或中风发病率之间存在线性关系。在正常血糖受试者中，与SBP119≤的最低五分位数相比，较高的收缩压五分位数2-5(分别为12 0-12 9、130-139、140-149和15 0≤)的冠心病危险比(HR)从五分位数2的2.10(95%可信区间，1.73-2.5 6)递增到5分位数的3.2 1(2.37-4.34)。在血糖正常的受试者中，卒中的心率从五分位数2的1.46(1.27-1.68)增加到五分位数5的4.76(3.94-5.75)。类似地，冠心病和中风的HR分别从五分位数2的1.39(1.14-1.69)和1.70(1.44-2.01)逐步增加到五分之一位数5的2.52(1.95-3.26)和4.12(3.38-5.02)，在临界高血糖人群中，糖尿病患者从二分之一的1.50(1.19~1.90)和1.72(1.31~2.26)下降到五分之一的2.52(1.95~3.26)和3.54(2.66~4.70)。与舒张压最低的五分位数74≤≤相比，最高五分位数的2-5分位数(分别为75-79、80-84、85-89和90毫米汞柱)的舒张压也有类似的趋势。这些观察是新颖的，因为它们表明SBP/DBP与心血管风险之间不仅在普通人群中存在线性关系，而且在正常血糖和临界血糖人群中也存在。值得注意的是，血压升高和血糖状况恶化对冠心病发病率有相加作用。与血糖水平正常和SBP<；120毫米汞柱的个体相比，糖尿病和SBP≥为150毫米汞柱的患者患冠心病的心率增加了8.4倍。相反，对于SBP≥为150毫米汞柱、血糖正常、临界高血糖和糖尿病的个体，卒中的HR分别保持在大约5.04.4.5.6，这表明高血压或血糖状态对卒中没有相加的影响。这项研究的优势不仅在于其庞大的样本量，而且还在于对冠心病和中风事件的准确定义，这些定义基于有关药物和程序的详细数据(即导管介入、搭桥手术、溶栓治疗和血管内血栓切除术)，而不仅仅来自ICD码或…的保险
The brain and heart are major target organs for hypertension, along with the kidneys. A large-scale meta-analysis of 61 prospective observational studies on blood pressure (BP) and mortality that included 958,074 adults with no previous cardiovascular disease demonstrated that the mortality rates for coronary artery disease (CAD) and stroke increase exponentially with elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels, without any evidence of a threshold down to at least 115/75 mmHg [1]. Moreover, similar associations were shown for populations in the age range of 50 to 89 years, regardless of sex. EPOCH-JAPAN, a meta-analysis of 10 cohort studies that included approximately 70,000 individuals in Japan, showed that the association between SBP/DBP level and cardiovascular disease mortality was almost logarithmically linear and that the risk was lowest among individuals with BP levels< 120/80 mmHg in both middle-aged (40–64 years) and elderly (65–74 years) age groups [2]. Recently, Yamada et al. investigated the associations between BP and the incidence of CAD or stroke according to glucose status by analyzing data from a nationwide claimsbased database that included information on 805,992 adults with no prior cardiovascular disease enrolled with a health insurance provider for company employees and their dependents in Japan [3]. They found a linear relationship between SBP and DBP and CAD or stroke morbidity regardless of the presence or severity of abnormal glucose levels. Compared with the lowest quintile of SBP≤ 119 mmHg, hazard ratios (HRs) for CAD in the higher SBP quintiles 2–5 (120–129, 130–139, 140–149, and 150≤ mmHg, respectively) progressively increased from 2.10 (95% confidence interval, 1.73–2.56) in quintile 2 to 3.21 (2.37–4.34) in quintile 5 among normoglycemic subjects. The HR for stroke increased from 1.46 (1.27–1.68) in quintile 2 to 4.76 (3.94–5.75) in quintile 5 among normoglycemic subjects. Similarly, the HRs for CAD and stroke progressively increased from 1.39 (1.14–1.69) and 1.70 (1.44–2.01) in quintile 2 to 2.52 (1.95–3.26) and 4.12 (3.38–5.02) in quintile 5, respectively, among borderline hyperglycemic subjects and from 1.50 (1.19–1.90) and 1.72 (1.31–2.26) in quintile 2 to 2.52 (1.95–3.26) and 3.54 (2.66–4.70) in quintile 5, respectively, among those with diabetes. A similar trend was observed for DBP across the highest quintiles 2–5 (75–79, 80–84, 85–89, and 90≤ mmHg, respectively) compared with the lowest quintile of DBP≤ 74mmHg. These observations are novel since they show that a linear relationship between SBP/DBP and cardiovascular risks is present not only in the general population but also in populations with normoglycemia and borderline glycemia. Notably, BP elevation and worsening glucose status have an additive effect on CAD morbidity. Compared to individuals with normal glucose levels and an SBP< 120 mmHg, the HR for CAD increased 8.4-fold among those with diabetes and an SBP≥ 150 mmHg. In contrast, the HRs for stroke remained similar at approximately 5.0, 4.4, and 5.6 for individuals with an SBP≥ 150 mmHg who had normoglycemia, borderline hyperglycemia, and diabetes, respectively, suggesting that there is no additive effect of hypertension or glycemic status for stroke. The strengths of this study were not only its large sample size but also the accurate definitions of CAD and stroke events that were based on detailed data regarding medications and procedures (ie, catheter intervention, bypass surgery, thrombolytic therapy, and endovascular thrombectomy) and not solely derived from ICD codes or insurance …
影响因子：
24
作者：
Kitamura, Akihiko;Sato, Shinichi;Komachi, Yoshio
通讯作者：
Komachi, Yoshio
DOI：
10.1016/s0145-4145(09)79511-5
发表时间：
2009
期刊：
Yearbook of Cardiology
影响因子：
--
作者：
B. Gersh
通讯作者：
B. Gersh
影响因子：
5
作者：
Rumana, Nahid;Kita, Yoshikuni;Ueshima, Hirotsugu
通讯作者：
Ueshima, Hirotsugu