广东省人民医院Hao Chen研究了年轻人高血压与长期心血管事件的相关性。2020年9月9日，该研究发表在《英国医学杂志》上。
为了评价和量化青年高血压患者心血管事件的未来风险，研究组在Medline、Embase和科学引文索引数据库中检索2020年3月6日之前的文章，筛选出关于青年高血压心血管事件的研究，并进行系统回顾和荟萃分析。研究对象为18-45岁的高血压成人，主要结局为心血管事件的综合结局。
17个观察组中大约有450万年轻人纳入分析，平均随访时间为14.7年。血压正常的年轻人与最理想血压的成年人相比，发生心血管事件的风险增加，相对风险为1.19。血压级别与心血管事件风险增加之间存在分级递进关系，其中正常高血压的相对风险为1.35，1级高血压为1.92，2级高血压为3.15。
冠心病和中风也观察到相似结果。一般来说，与血压升高相关的心血管事件的人群归因分数为23.8％。血压正常的参与者中治疗1年以预防1次心血管事件所需人数为2672人，高于正常血压的参与者为1450人，1级高血压患者为552人，2级高血压患者为236人。
总之，血压升高的年轻人在之后生活中患心血管疾病的风险可能会略微增加。
附：英文原文
Title: Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis
Author: Dongling Luo, Yunjiu Cheng, Haifeng Zhang, Mingchuan Ba, Pengyuan Chen, Hezhi Li, Kequan Chen, Weihong Sha, Caojin Zhang, Hao Chen
Issue&Volume: 2020/09/09
Abstract:
Objective To evaluate and quantify the future risk of cardiovascular events in young adults with high blood pressure.
Design Systematic review and meta-analysis.
Data sources Medline, Embase, and Web of Science were searched from inception to 6 March 2020. Relative risks were pooled using a random effects model and expressed with 95% confidence intervals. Absolute risk difference was calculated. Dose-response relations between blood pressure and individual outcomes were assessed by a restricted cubic spline model.
Eligibility criteria for selecting studies Studies were selected that investigated the adverse outcomes of adults aged 18-45 with raised blood pressure. The primary study outcome was a composite of total cardiovascular events. Coronary heart disease, stroke, and all cause mortality were examined as secondary outcomes.
Results Seventeen observational cohorts consisting of approximately 4.5 million young adults were included in the analysis. The average follow-up was 14.7 years. Young adults with normal blood pressure had increased risk of cardiovascular events compared with those with optimal blood pressure (relative risk 1.19, 95% confidence interval 1.08 to 1.31; risk difference 0.37, 95% confidence interval 0.16 to 0.61 per 1000 person years). A graded, progressive association was found between blood pressure categories and increased risk of cardiovascular events (high normal blood pressure: relative risk 1.35, 95% confidence interval 1.22 to 1.49; risk difference 0.69, 95% confidence interval 0.43 to 0.97 per 1000 person years; grade 1 hypertension: 1.92, 1.68 to 2.19; 1.81, 1.34 to 2.34; grade 2 hypertension: 3.15, 2.31 to 4.29; 4.24, 2.58 to 6.48). Similar results were observed for coronary heart disease and stroke. Generally, the population attributable fraction for cardiovascular events associated with raised blood pressure was 23.8% (95% confidence interval 17.9% to 28.8%). The number needed to treat for one year to prevent one cardiovascular event was estimated at 2672 (95% confidence interval 1639 to 6250) for participants with normal blood pressure, 1450 (1031 to 2326) for those with high normal blood pressure, 552 (427 to 746) for those with grade 1 hypertension, and 236 (154 to 388) for those with grade 2 hypertension.
Conclusions Young adults with raised blood pressure might have a slightly increased risk of cardiovascular events in later life. Because the evidence for blood pressure lowering is limited, active interventions should be cautious and warrant further investigation.
DOI: 10.1136/bmj.m3222
Source: https://www.bmj.com/content/370/bmj.m3222
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
