Blood pressure in early adulthood, hypertension in middle age, and future cardiovascular disease mortality: HAHS (Harvard Alumni Health Study).
Blood pressure in early adulthood, hypertension in middle age, and future cardiovascular disease mortality: HAHS (Harvard Alumni Health Study).
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DOI：
10.1016/j.jacc.2011.07.045
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发表时间：
2011-11-29
影响因子：
24
通讯作者：
Batty, G. David
中科院分区：
文献类型：
--
作者：
Gray, Linsay;Lee, I-Min;Sesso, Howard D.;Batty, G. David
研究成年早期血压与CVD死亡率的关系，同时考虑中年高血压。中年血压升高是一个确定的CVD风险因素，但与生命早期测量相关的证据很少。HAHS是一项对18，881名男性大学生进行的队列研究，他们在大学入学时（1914 - 1952年;平均年龄18.3岁）测量了血压，并在1962/1966年（平均年龄45.8岁）邮寄了一份调查问卷，其中报告了医生诊断的高血压状态。随后对研究成员的死亡率进行了随访，直到1998年底。在调整了年龄、BMI、吸烟和大学入学时的体育活动后，与根据JNC-7标准血压正常的男性相比，（<120/<80 mmHg）冠心病死亡率增高（1，917例死亡）在高血压前期患者中（120-139/80-89 mmHg）（风险比; 95%置信区间：1.21; 1.07，1.36），第1阶段（140-159/90-99 mmHg）（1.46; 1.25，1.70）和2期高血压（≥160/≥100 mmHg）（1.89; 1.46，2.45），各类别间递增（p趋势<0.001）。在额外考虑中年高血压后，估计值有所减弱，但模式仍然存在。总死亡率和心血管疾病死亡率也有类似的相关性，但卒中死亡率没有相关性。成年早期的高血压与全因死亡率、心血管疾病和冠心病的风险升高相关，但与几十年后的中风无关。考虑到中年高血压的调解后，效果基本上持续存在。因此，在成年早期降低血压的长期益处是有希望的，但需要支持性试验数据。
To examine the association of early adulthood blood pressure with CVD mortality, while accounting for middle-age hypertension. Elevated blood pressure in middle-age is an established CVD risk factor, but evidence for association with measurements earlier in life is sparse. HAHS is a cohort study of 18,881 male university students who had blood pressure measured at university entry (1914 –1952; mean age 18.3 years) and who responded to a questionnaire mailed in 1962/1966 (mean age 45.8 years) in which physician-diagnosed hypertension status was reported. Study members were subsequently followed for mortality until the end of 1998. Following adjustment for age, BMI, smoking and physical activity at college entry, compared to men who were normotensive according to JNC-7 criteria (<120/<80mmHg) there was an elevated risk of CHD mortality (1,917 deaths) in those who were pre-hypertensive (120–139/80–89 mmHg) (hazards ratio; 95% confidence intervals: 1.21; 1.07, 1.36), stage 1 (140–159/90–99 mmHg) (1.46; 1.25, 1.70), and stage 2 hypertensive (≥160/≥100 mmHg) (1.89; 1.46, 2.45), incremental across categories (ptrend<0.001). After additional account for middle-age hypertension, estimates were somewhat attenuated but the pattern remained. Similar associations were apparent for total and CVD but not stroke mortality. Higher blood pressure in early adulthood was associated with elevated risk of mortality from all-causes, CVD and CHD, but not stroke several decades later. Effects largely persisted after taking account of mediation by middle-age hypertension. Thus, the long-term benefits of blood pressure lowering in early adulthood are promising but supporting trial data are required.
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