The progression from hypertension to congestive heart failure
The progression from hypertension to congestive heart failure
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DOI：
10.1001/jama.275.20.1557
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发表时间：
1996-05-22
影响因子：
120.7
通讯作者：
Ho, KKL
中科院分区：
文献类型：
--
作者：
Levy, D;Larson, MG;Ho, KKL
目的：研究高血压发展为充血性心力衰竭的相对和人群可归因性风险，评估高血压发展为充血性心力衰竭的时间进程，并确定导致高血压受试者发生明显心力衰竭的危险因素。设计-初始队列研究设置-普通社区参与者-原始弗雷明翰心脏研究和弗雷明汉后代研究参与者，年龄在40岁至之间，没有心力衰竭。为了反映更多的当代经验，这项研究的起点是1970年1月1日。暴露措施。-高血压(血压至少140 mm Hg收缩压或90 mm Hg舒张压或目前正在使用治疗高血压的药物)和其他潜在的CHF危险因素在定期的临床检查中被评估。结果测量。-CHF的发展。结果：总共5143名符合条件的受试者贡献了72 422人年的观察。在长达20.1年的随访中(平均14.1年)，有392例新的心力衰竭病例；在91%(357/392)的病例中，高血压先于心力衰竭的发展。在比例风险回归模型中调整年龄和心力衰竭风险因素后，与正常血压受试者相比，高血压患者发生心力衰竭的风险约为男性的2倍和女性的3倍。多变量分析显示，高血压对CHF有很高的人群归因风险，占男性病例的39%，女性病例的59%。在高血压受试者中，心肌梗死、糖尿病、左心室肥厚和瓣膜心脏病是男女CHF风险增加的预测因素。高血压充血性心力衰竭发病后的存活率很低；只有24%的男性和31%的女性存活了5年。结论：高血压是充血性心力衰竭最常见的危险因素，在这个以人群为基础的样本中，高血压占心力衰竭病例的很大比例。针对更早和更积极的血压控制的预防策略可能为降低CHF的发生率及其相关死亡率提供最大的希望。
Objectives.-To study the relative and population-attributable risks of hypertension for the development of congestive heart failure (CHF), to assess the time course of progression from hypertension to CHF, and to identify risk factors that contribute to the development of overt heart failure in hypertensive subjects.Design.-Inception cohort study.Setting.-General community.Participants.-Original Framingham Heart Study and Framingham Offspring Study participants aged 40 to 89 years and free of CHF. To reflect more contemporary experience, the starting point of this study was January 1, 1970.Exposure Measures.-Hypertension (blood pressure of at least 140 mm Hg systolic or 90 mm Hg diastolic or current use of medications for treatment of high blood pressure) and other potential CHF risk factors were assessed at periodic clinic examinations.Outcome Measure.-The development of CHF.Results.-A total of 5143 eligible subjects contributed 72 422 person-years of observation. During up to 20.1 years of follow-up (mean, 14.1 years), there were 392 new cases of heart failure; in 91% (357/392), hypertension antedated the development of heart failure. Adjusting for age and heart failure risk factors in proportional hazards regression models, the hazard for developing heart failure in hypertensive compared with normotensive subjects was about 2-fold in men and 3-fold in women. Multivariable analyses revealed that hypertension had a high population-attributable risk for CHF, accounting for 39% of cases in men and 59% in women. Among hypertensive subjects, myocardial infarction, diabetes, left ventricular hypertrophy, and valvular heart disease were predictive of increased risk for CHF in both sexes. Survival following the onset of hypertensive CHF was bleak; only 24% of men and 31% of women survived 5 years.Conclusions.-Hypertension was the most common risk factor for CHF, and it contributed a large proportion of heart failure cases in this population-based sample. Preventive strategies directed toward earlier and more aggressive blood pressure control are likely to offer the greatest promise for reducing the incidence of CHF and its associated mortality.