From "prehypertension" to hypertension? Additional evidence
From "prehypertension" to hypertension? Additional evidence
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DOI：
10.1016/j.annepidem.2005.02.010
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发表时间：
2005-10-01
影响因子：
5.6
通讯作者：
Winegarden, CR
中科院分区：
文献类型：
--
作者：
Winegarden, CR
目的：最近的美国指南重新定义了血压的分类，对于新的“高血压前期”分类（收缩压，120-139，舒张压，80-89）产生了持续的争议，这表明进展为完全高血压的风险增加，需要改变生活方式和频繁随访。这项研究解决了一个尚未完全探索的经验问题：高血压前期如何很好地预测早期过渡到高血压？方法：从相隔7年的两次英国健康和生活方式调查中获得的血压和其他纵向数据，用于形成2048名基线血压正常的男性和女性的子样本。高血压前期分为“正常”（收缩压，120-129；舒张压，80-85）和“高正常”（收缩压，130-139；舒张压，85-89），以“最佳”（收缩压，< 120；舒张压< 80）为参考。采用二项回归估计随访时高血压的校正相对危险度（RR）和置信区间（CI）。当结果常见时，这是一种合适的方法（比逻辑回归更可取）。结果：“正常”亚类的估计RR为2.0 (CI, 1.6, 2.6)，“高正常”的估计RR为2.9 （CI, 2.3, 3.7）。按年龄组进行的单独回归显示，35至44岁的高正常者风险最大。结论：结果支持高血压前期效应的假设，特别是对于年轻的高正常者，但比基于framingham的估计更保守。
PURPOSE: Recent U.S. guidelines redefining blood-pressure categories have generated a continuing controversy regarding the new "prehypertensive" category (systolic, 120-139, diastolic, 80-89), signifying heightened risk of progression to outright hypertension and a need for lifestyle changes and frequent follow-up. This study addresses an incompletely-explored empirical question: how well does prehypertension predict an early transition to hypertension?METHODS: Blood-pressure and other longitudinal data obtained from two British Health and Lifestyle Surveys conducted 7 years apart were used to form a subsample of 2048 men and women normotensive at baseline. Prehypertension was divided into subcategories: "normal" (systolic, 120-129; diastolic, 80-85) and "high normal" (systolic, 130-139; diastolic, 85-89), with "optimal" (systolic, < 120; diastolic < 80) as reference. Binomial regression was used to estimate adjusted relative risks (RR) and confidence intervals (CI) for hypertension at follow-up. This is an appropriate method (and preferable to logistic regression) when the outcome is common.RESULTS: Estimated RR for the "normal" subcategory was 2.0 (CI, 1.6, 2.6) and for "high normals," 2.9 (CI, 2.3, 3.7). Separate regressions by age bracket showed the greatest risks for high normals aged 35 to 44 years.CONCLUSIONS: The results support the hypothesized prehypertension effects, especially for younger high normals, but are more conservative than the Framingham-based estimates.