The progression from hypertension to congestive heart failure.
The progression from hypertension to congestive heart failure.
复制标题
DOI：
10.1001/jama.1996.03530440037034
复制
发表时间：
1996-05
期刊：
影响因子：
--
通讯作者：
Daniel Levy;M. Larson;R. Vasan;W. Kannel
中科院分区：
文献类型：
--
作者：
Daniel Levy;M. Larson;R. Vasan;W. Kannel
目的-研究高血压发展为充血性心力衰竭（CHF）的相对和人群归因风险，评估从高血压进展为CHF的时间进程，并确定高血压受试者中导致明显心力衰竭发展的风险因素。设计-初始队列研究。设置-一般社区。参与者-原始心脏病研究和心脏病后代研究参与者，年龄40 - 89岁，无CHF。为了反映更多的当代经验，这项研究的起点是1970年1月1日。暴露测量-在定期临床检查时评估高血压（收缩压至少140 mm Hg或舒张压至少90 mm Hg或目前使用药物治疗高血压）和其他潜在CHF风险因素。结果测量-CHF的发展。结果-共有5143名合格受试者参与了72422人-年的观察。在长达20.1年的随访期间（平均14.1年），有392例新发心力衰竭病例;在91%（357/392）中，高血压先于心力衰竭的发展。在比例风险回归模型中调整年龄和心力衰竭危险因素后，高血压患者发生心力衰竭的风险男性约为血压正常者的2倍，女性约为3倍。多变量分析显示，高血压对CHF具有较高的人群归因风险，男性占39%，女性占59%。在高血压受试者中，心肌梗死、糖尿病、左心室肥厚和心脏瓣膜病是两种性别CHF风险增加的预测因素。高血压CHF发作后的生存率很低，只有24%的男性和31%的女性存活5年。结论：高血压是CHF最常见的危险因素，在这个以人群为基础的样本中，高血压在心力衰竭病例中占很大比例。针对早期和更积极的血压控制的预防策略可能为降低CHF的发病率及其相关死亡率提供最大的希望。
OBJECTIVES - To study the relative and population-attributable risks of hypertension for the development of congestive heart failure (CHF), to assess the time course of progression from hypertension to CHF, and to identify risk factors that contribute to the development of overt heart failure in hypertensive subjects. DESIGN - Inception cohort study. SETTING - General community. PARTICIPANTS - Original Framingham Heart Study and Framingham Offspring Study participants aged 40 to 89 years and free of CHF. To reflect more contemporary experience, the starting point of this study was January 1, 1970. EXPOSURE MEASURES - Hypertension (blood pressure of at least 140 mm Hg systolic or 90 mm Hg diastolic or current use of medications for treatment of high blood pressure) and other potential CHF risk factors were assessed at periodic clinic examinations. OUTCOME MEASURE - The development of CHF. RESULTS - A total of 5143 eligible subjects contributed 72422 person-years of observation. During up to 20.1 years of follow-up (mean, 14.1 years), there were 392 new cases of heart failure; in 91% (357/392), hypertension antedated the development of heart failure. Adjusting for age and heart failure risk factors in proportional hazards regression models, the hazard for developing heart failure in hypertensive compared with normotensive subjects was about 2-fold in men and 3-fold in women. Multivariable analyses revealed that hypertension had a high population-attributable risk for CHF, accounting for 39% of cases in men and 59% in women. Among hypertensive subjects, myocardial infarction, diabetes, left ventricular hypertrophy, and valvular heart disease were predictive of increased risk for CHF in both sexes. Survival following the onset of hypertensive CHF was bleak; only 24% of men and 31% of women survived 5 years. CONCLUSIONS - Hypertension was the most common risk factor for CHF, and it contributed a large proportion of heart failure cases in this population-based sample. Preventive strategies directed toward earlier and more aggressive blood pressure control are likely to offer the greatest promise for reducing the incidence of CHF and its associated mortality.