Blood pressure levels and risk of cardiovascular disease mortality among Japanese men and women: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study).
Blood pressure levels and risk of cardiovascular disease mortality among Japanese men and women: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study).
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DOI：
10.1097/hjh.0000000000002073
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发表时间：
2019-07
影响因子：
4.9
通讯作者：
K. Yamagishi;S. Sawachi;A. Tamakoshi;H. Iso
中科院分区：
文献类型：
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作者：
K. Yamagishi;S. Sawachi;A. Tamakoshi;H. Iso
目的 检查现实世界中血压 (BP) 与心血管死亡率的关联，并调查这种关联是否因基线时抗高血压药物的使用而变化。方法 本研究使用了 27 728 名年龄在 40-79 岁、在入组时（1988-1990 年）无中风、冠心病、癌症和肾病的日本男性和女性的数据。 2009 年完成了死亡率监测，每年跟踪 449 800 人。入院时按血压类别（基于 2018 年欧洲指南）分析心血管死亡的风险比。结果 1477 人死于心血管疾病 (CVD)。相对于入院时的正常高血压，CVD 最佳血压的多变量风险比（95% 置信区间）为 0.85 (0.69-1.04)；正常血压为 0.96 (0.81-1.15)； 1级高血压为1.26（1.09-1.46）； 2-3 级高血压为 1.55 (1.31-1.84)。在入院时未服用抗高血压药物的人中也观察到了类似的线性相关性。在接受高血压治疗的患者中，观察到与 CVD 死亡率呈 U 形关联；风险比分别 = 2.31 (1.25-4.27)、1.68 (1.05-2.69)、1.56 (1.10-2.22) 和 1.63 (1.13-2.36)。中风和冠心病也观察到类似的模式，尽管并不总是具有统计学意义。结论 基线时的血压类别与总体 CVD 死亡率呈线性正相关，在未服用抗高血压药物的参与者中也是如此。在已接受高血压治疗且血压正常且处于最佳状态的患者中，观察到心血管疾病死亡的风险高于血压正常高值的患者，这表明仔细监测此类患者的血压和合并症的重要性。
OBJECTIVE To examine the association of blood pressure (BP) with cardiovascular mortality in real-world settings and investigate whether that association varied by use of antihypertensive medication at baseline. METHODS Data from 27 728 Japanese men and women, aged 40-79 years, free of stroke, coronary heart disease, cancer, and kidney disease at entry (1988-1990) were used in this study. Mortality surveillance was completed through 2009, resulting in 449 800 person-years of follow-up. Hazard ratios for cardiovascular mortality were analysed by BP category (based on 2018 European guidelines) at admission. RESULTS There were 1477 deaths from cardiovascular diseases (CVDs). Relative to high-normal BP at admission, the multivariable hazard ratios (95% confidence intervals) of CVD were 0.85 (0.69-1.04) for optimal BP; 0.96 (0.81-1.15) for normal BP; 1.26 (1.09-1.46) for Grade 1 hypertension; and 1.55 (1.31-1.84) for Grade 2-3 hypertension. A similar linear association was observed among persons not taking antihypertensive medication at admission. Among patients treated for hypertension, a U-shaped association with CVD mortality was observed; hazard ratios = 2.31 (1.25-4.27), 1.68 (1.05-2.69), 1.56 (1.10-2.22), and 1.63 (1.13-2.36), respectively. Similar patterns were observed for stroke and coronary heart disease, although not always statistically significant. CONCLUSION BP categories at baseline were linearly and positively associated with CVD mortality overall and also among participants not taking antihypertensive medication. A higher risk of mortality from CVD was observed among patients already treated for hypertension with optimal and normal BPs than those with high-normal BP, suggesting the importance of careful monitoring of BP and comorbidities of such patients.