Blood pressure as a cardiovascular risk factor - Prevention and treatment
Blood pressure as a cardiovascular risk factor - Prevention and treatment
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DOI：
10.1001/jama.275.20.1571
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发表时间：
1996-05-22
影响因子：
120.7
通讯作者：
Kannel, WB
中科院分区：
文献类型：
--
作者：
Kannel, WB
客观。-检查高血压的患病率，发病率，易感因素，其危害作为心血管风险特征的一个组成部分，以及这些信息对预防和治疗的影响。前瞻性纵向分析的36年随访数据从前期血压的相关性研究随后的心血管疾病发病率和死亡率的发生取决于代谢相关的负担相关的危险因素。高血压是心血管疾病的最普遍和最强大的贡献者之一，心血管疾病是美国的主要死亡原因。从30岁到65岁，收缩压平均增加20 mm Hg，舒张压平均增加10 mm Hg。单纯收缩期高血压是主要类型。尽管高血压的检测和治疗有所改善，但没有证据表明40年来高血压的患病率有所下降。高血压导致所有主要动脉粥样硬化性心血管疾病的结局，平均增加风险2- 3倍。冠状动脉疾病是最致命和最常见的后遗症，应得到最优先重视。高血压与血脂异常、胰岛素抵抗、葡萄糖耐受不良和肥胖聚集在一起，单独发生率低于20%。危害取决于这些相关代谢相关风险因素的数量。同时存在的显性心血管疾病也会影响治疗的风险和选择。高血压患病率没有下降，这表明迫切需要通过控制体重、锻炼、减少盐和酒精的摄入来进行初级预防。现有高血压治疗的紧迫性和选择应基于多变量心血管风险特征，更适合高血压患者治疗和预防心血管后遗症。
Objective.-To examine the prevalence, incidence, predisposing factors for hypertension, its hazards as an ingredient of the cardiovascular risk profile, and the implications of this information for prevention and treatment.Methods.-Prospective longitudinal analysis of 36-year follow-up data from the Framingham Study of the relation of antecedent blood pressure to occurrence of subsequent cardiovascular morbidity and mortality depending on the metabolically linked burden of associated risk factors.Results.-Hypertension is one of the most prevalent and powerful contributors to cardiovascular diseases, the leading cause of death in the United States. There is, on average, a 20 mm Hg systolic and 10 mm Hg diastolic increment increase in blood pressure from age 30 to 65 years. Isolated systolic hypertension is the dominant variety. There is no evidence of a decline in the prevalence of hypertension over 4 decades despite improvements in its detection and treatment. Hypertension contributes to all of the major atherosclerotic cardiovascular disease outcomes increasing risk, on average, 2- to 3-fold. Coronary disease, the most lethal and common sequela, deserves highest priority. Hypertension clusters with dyslipidemia, insulin resistance, glucose intolerance, and obesity, occurring in isolation in less than 20%. The hazard depends on the number of these associated metabolically linked risk factors present. Coexistent overt cardiovascular disease also influences the hazard and choice of therapy.Conclusion.-The absence of a decline in the prevalence of hypertension indicates an urgent need for primary prevention by weight control, exercise, and reduced salt and alcohol intake. The urgency and choice of therapy of existing hypertension should be based on the multivariate cardiovascular risk profile that more appropriately targets hypertensive persons for treatment and prevention of cardiovascular sequelae.