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研究意义深远！ JACC开滦研究新分析：<45岁高血压危险

2020-06-10 朱朱 文韬 中国循环杂志

高血压
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在评估心血管风险时，目前指南并未建议考虑高血压发病年龄，也没有强调对年轻患者进行适当治疗的重要性。

在评估心血管风险时，目前指南并未建议考虑高血压发病年龄，也没有强调对年轻患者进行适当治疗的重要性。
 
而近日，解放军总医院薛浩和唐山开滦总医院吴寿岭教授等在JACC发表的开滦研究最新分析表明，高血压发病越早，心血管病和全因死亡风险越高。
 
同期述评指出，这项研究的意义深远。因为，“与老年才发生的高血压患者相比，有高血压的年轻人的终生心血管病风险明显较高。”
 
述评还建议，未来指南在更新时，应考虑修改年轻高血压患者的治疗策略。
 
在该研究中，多因素分析发现，随着高血压发病年龄增大，心血管病和死亡风险逐渐降低。
 
与无高血压者相比，不到45岁就确诊高血压的年轻人中，心血管病和全因死亡风险分别增加1.26倍和1.59倍。
 
在45~54岁期间确诊高血压的患者中，心血管病和全因死亡风险分别增加62%和112%。
 
在55~64岁期间确诊高血压的患者中，心血管病和全因死亡风险分别增加42%和30%。
 
在≥65岁出现高血压的患者中，心血管病和全因死亡风险分别增加33%和29%。
 
述评也指出，评估高血压发病年龄，可能有助于改善心血管病风险分层。另外，早发高血压可能需要更强的降压治疗策略，包括生活方式干预和降压药物治疗。
 
近期发表的一些研究提示，与老年时期出现的高血压相比，中年时期出现的高血压患者未来痴呆风险更高。
 
根据中国高血压调查研究，中国18~24岁、25~34和35~44岁人群中，高血压的患病率分别为4.0%、6.1%和15.1%。但越是在年轻人中，高血压控制率反而越低，上述三个人群的控制率仅仅0.6%、3.2%和9.9%，远远低于其他更大年龄组。
 
开滦研究为一项前瞻性队列研究，这项最新分析纳入其中首次调查期间（2006年7月至2007年10月）入选的71 245名无高血压和心血管病的成年人，所有人随访至2017年年末。
 
随访期间，20 221人确诊新发高血压，研究人员将年龄和性别与之相匹配的19 887名无高血压的成年人作为对照。
 
平均随访6.5年期间，发生1672例心血管事件，2008人死亡。
 
来源：
[1]Association of Age of Onset of Hypertension With Cardiovascular Diseases and Mortality. J Am Coll Cardiol, 2020, 75(23): 2921-2930.
[2]Early-Onset Hypertension: Under-Recognized, Under-Treated, and Under-Estimated in Risk. J Am Coll Cardiol, 2020, 75(23): 2931-2933.
[3]Wang Z; Chen Z; Zhang L, et al. Statusof Hypertension in China: Results from the China Hypertension Survey, 2012-2015. Circulation. 2018; 137(22): 2344-2356.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2058160, encodeId=d6482058160a4, content=<a href='/topic/show?id=5e4d1348d5' target=_blank style='color:#2F92EE;'>#45岁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1348, encryptionId=5e4d1348d5, topicName=45岁)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Thu May 06 11:00:23 CST 2021, time=2021-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992760, encodeId=2fbc1992e6099, content=<a href='/topic/show?id=cf29e339326' target=_blank style='color:#2F92EE;'>#研究意义#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73393, encryptionId=cf29e339326, topicName=研究意义)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d4902500082, createdName=1249883fm12暂无昵称, createdTime=Sun Jan 24 09:00:23 CST 2021, time=2021-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1854800, encodeId=ee3018548004f, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Aug 27 20:00:23 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883988, encodeId=0ed688398878, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76d12257050, createdName=12177770m58暂无昵称, createdTime=Wed Sep 09 22:07:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1946785, encodeId=7e411946e8589, content=<a href='/topic/show?id=a25e4966e43' target=_blank style='color:#2F92EE;'>#开滦研究#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49667, encryptionId=a25e4966e43, topicName=开滦研究)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b71f2500114, createdName=1179102698_36768926, createdTime=Wed Aug 26 20:00:23 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326647, encodeId=8b7c132664e58, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Jun 12 09:00:23 CST 2020, time=2020-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=601997, encodeId=331a60199ee4, content=<a href='/topic/show?id=974e51e2810' target=_blank style='color:#2F92EE;'>#心血管#</a>高血压发病越早，心血管病和全因死亡风险越高。同样肥胖也是如此，糖尿病也是一样，青少年的陪伴和青少年的糖尿病对日后的危害是更大的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=336, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51728, encryptionId=974e51e2810, topicName=心血管)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Wed Jun 10 22:11:29 CST 2020, time=2020-06-10, status=1, ipAttribution=)]
    2021-05-06 zhmscau

    #45岁#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=2058160, encodeId=d6482058160a4, content=<a href='/topic/show?id=5e4d1348d5' target=_blank style='color:#2F92EE;'>#45岁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1348, encryptionId=5e4d1348d5, topicName=45岁)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Thu May 06 11:00:23 CST 2021, time=2021-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992760, encodeId=2fbc1992e6099, content=<a href='/topic/show?id=cf29e339326' target=_blank style='color:#2F92EE;'>#研究意义#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73393, encryptionId=cf29e339326, topicName=研究意义)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d4902500082, createdName=1249883fm12暂无昵称, createdTime=Sun Jan 24 09:00:23 CST 2021, time=2021-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1854800, encodeId=ee3018548004f, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Aug 27 20:00:23 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883988, encodeId=0ed688398878, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76d12257050, createdName=12177770m58暂无昵称, createdTime=Wed Sep 09 22:07:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1946785, encodeId=7e411946e8589, content=<a href='/topic/show?id=a25e4966e43' target=_blank style='color:#2F92EE;'>#开滦研究#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49667, encryptionId=a25e4966e43, topicName=开滦研究)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b71f2500114, createdName=1179102698_36768926, createdTime=Wed Aug 26 20:00:23 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326647, encodeId=8b7c132664e58, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Jun 12 09:00:23 CST 2020, time=2020-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=601997, encodeId=331a60199ee4, content=<a href='/topic/show?id=974e51e2810' target=_blank style='color:#2F92EE;'>#心血管#</a>高血压发病越早，心血管病和全因死亡风险越高。同样肥胖也是如此，糖尿病也是一样，青少年的陪伴和青少年的糖尿病对日后的危害是更大的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=336, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51728, encryptionId=974e51e2810, topicName=心血管)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Wed Jun 10 22:11:29 CST 2020, time=2020-06-10, status=1, ipAttribution=)]
    2021-01-24 1249883fm12暂无昵称

    #研究意义#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2058160, encodeId=d6482058160a4, content=<a href='/topic/show?id=5e4d1348d5' target=_blank style='color:#2F92EE;'>#45岁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1348, encryptionId=5e4d1348d5, topicName=45岁)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Thu May 06 11:00:23 CST 2021, time=2021-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992760, encodeId=2fbc1992e6099, content=<a href='/topic/show?id=cf29e339326' target=_blank style='color:#2F92EE;'>#研究意义#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73393, encryptionId=cf29e339326, topicName=研究意义)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d4902500082, createdName=1249883fm12暂无昵称, createdTime=Sun Jan 24 09:00:23 CST 2021, time=2021-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1854800, encodeId=ee3018548004f, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Aug 27 20:00:23 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883988, encodeId=0ed688398878, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76d12257050, createdName=12177770m58暂无昵称, createdTime=Wed Sep 09 22:07:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1946785, encodeId=7e411946e8589, content=<a href='/topic/show?id=a25e4966e43' target=_blank style='color:#2F92EE;'>#开滦研究#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49667, encryptionId=a25e4966e43, topicName=开滦研究)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b71f2500114, createdName=1179102698_36768926, createdTime=Wed Aug 26 20:00:23 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326647, encodeId=8b7c132664e58, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Jun 12 09:00:23 CST 2020, time=2020-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=601997, encodeId=331a60199ee4, content=<a href='/topic/show?id=974e51e2810' target=_blank style='color:#2F92EE;'>#心血管#</a>高血压发病越早，心血管病和全因死亡风险越高。同样肥胖也是如此，糖尿病也是一样，青少年的陪伴和青少年的糖尿病对日后的危害是更大的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=336, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51728, encryptionId=974e51e2810, topicName=心血管)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Wed Jun 10 22:11:29 CST 2020, time=2020-06-10, status=1, ipAttribution=)]
    2020-08-27 hbwxf

    #JACC#

    0

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    2020-09-09 12177770m58暂无昵称

    学习了

    0

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    2020-08-26 1179102698_36768926

    #开滦研究#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2058160, encodeId=d6482058160a4, content=<a href='/topic/show?id=5e4d1348d5' target=_blank style='color:#2F92EE;'>#45岁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1348, encryptionId=5e4d1348d5, topicName=45岁)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Thu May 06 11:00:23 CST 2021, time=2021-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992760, encodeId=2fbc1992e6099, content=<a href='/topic/show?id=cf29e339326' target=_blank style='color:#2F92EE;'>#研究意义#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73393, encryptionId=cf29e339326, topicName=研究意义)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d4902500082, createdName=1249883fm12暂无昵称, createdTime=Sun Jan 24 09:00:23 CST 2021, time=2021-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1854800, encodeId=ee3018548004f, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Thu Aug 27 20:00:23 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=883988, encodeId=0ed688398878, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76d12257050, createdName=12177770m58暂无昵称, createdTime=Wed Sep 09 22:07:43 CST 2020, time=2020-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1946785, encodeId=7e411946e8589, content=<a href='/topic/show?id=a25e4966e43' target=_blank style='color:#2F92EE;'>#开滦研究#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49667, encryptionId=a25e4966e43, topicName=开滦研究)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b71f2500114, createdName=1179102698_36768926, createdTime=Wed Aug 26 20:00:23 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326647, encodeId=8b7c132664e58, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Jun 12 09:00:23 CST 2020, time=2020-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=601997, encodeId=331a60199ee4, content=<a href='/topic/show?id=974e51e2810' target=_blank style='color:#2F92EE;'>#心血管#</a>高血压发病越早，心血管病和全因死亡风险越高。同样肥胖也是如此，糖尿病也是一样，青少年的陪伴和青少年的糖尿病对日后的危害是更大的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=336, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51728, encryptionId=974e51e2810, topicName=心血管)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Wed Jun 10 22:11:29 CST 2020, time=2020-06-10, status=1, ipAttribution=)]
    2020-06-12 12498568m50暂无昵称

    #ACC#

    0

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    2020-06-10 lovetcm

    #心血管#高血压发病越早，心血管病和全因死亡风险越高。同样肥胖也是如此，糖尿病也是一样，青少年的陪伴和青少年的糖尿病对日后的危害是更大的。

    0

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