High Blood Pressure and Cardiovascular Disease.
High Blood Pressure and Cardiovascular Disease.
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DOI：
10.1161/hypertensionaha.119.14240
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发表时间：
2020-02
期刊：
影响因子：
8.3
通讯作者：
Whelton, Paul K.
中科院分区：
文献类型：
--
作者：
Fuchs, Flavio D.;Whelton, Paul K.
零散的调查掩盖了心血管疾病（CVD）病因的整体情况。在 CVD 的危险因素中，高血压 (BP) 与最有力的因果关系相关，并且其暴露率很高。血压的生物学正常水平远低于研究和临床实践中通常描述的正常水平。我们认为 CVD 主要是由 BP 人群分布右移引起的。我们认为血压是 CVD 主要危险因素的观点是基于已在观察研究和临床试验中得到检验的概念假设。大型队列研究表明，除了冠心病和中风之外，高血压也是心力衰竭、心房颤动、慢性肾病、心脏瓣膜疾病、主动脉综合征和痴呆的重要危险因素。在多变量模型中，随着逐渐使用较低的正常血压值，推测的高血压导致中风和冠心病的风险稳步增加。降低血压随机对照试验的荟萃分析表明，其益处与队列研究中血压风险关系的预测几乎相同。预防与年龄相关的血压升高将在很大程度上减少通常归因于衰老的血管后果，再加上对既定高血压的强化治疗将消除很大一部分与血压相关的心血管疾病的人口负担。
Fragmented investigation has masked the overall picture for causes of cardiovascular disease (CVD). Among the risk factors for CVD, high blood pressure (BP) is associated with the strongest evidence for causation and it has a high prevalence of exposure. Biologically normal levels of BP are considerably lower than what has typically been characterized as normal in research and clinical practice. We propose that CVD is primarily caused by a right-sided shift in the population distribution of BP. Our view that BP is the predominant risk factor for CVD is based on conceptual postulates that have been tested in observational investigations and clinical trials. Large cohort studies have demonstrated that high BP is an important risk factor for heart failure, atrial fibrillation, chronic kidney disease, heart valve diseases, aortic syndromes and dementia, in addition to coronary heart disease and stroke. In multivariate modelling, the presumed attributable risk of high BP for stroke and coronary heart disease has increased steadily with progressive use of lower values for normal BP. Meta-analysis of BP-lowering randomized controlled trials has demonstrated a benefit which is almost identical to that predicted from BP risk relationships in cohort studies. Prevention of age-related increases in BP would in large part reduce the vascular consequences usually attributed to aging, and together with intensive treatment of established hypertension would eliminate a large proportion of the population burden of BP-related CVD.