The Relationship of Systolic and Diastolic Blood Pressure to ：收缩压和舒张的关系

1、 percent hypertensive 18-29 based on nhanes iii (phase 1 and 2) hypertension defined as blood pressure 140/90 mmhg or treatment 30-3940-4950-5960-6970-7980+ age 3 % 9 % 18 % 38 % 51 % 66 % 72 % jnc-vi. arch intern med. 1997;157:2413-2446. risk of hypertension (%) residual lifetime risk of developing

2、 hypertension among people with blood pressure 140/90 mmhg years menwomen vasan rs, et al. jama. 2002; 287:1003-1010. copyright 2002, american medical association. 0 50 100 150 200 250 158- 167 148- 157 138- 147 128- 137 98- 127 98-102 93-97 88-92 83-87 68-82 society of actuaries. blood pressure stu

3、dy, 1939. ratio (%) of actual to expected mortality systolic blood pressure (mmhg) diastolic blood pressure (mmhg) age-adjusted annual incidence of chd per 1000 based on 30 year follow-up of framingham heart study subjects free of coronary heart disease (chd) at baseline systolic blood pressure (mmh

4、g)diastolic blood pressure (mmhg) framingham heart study, 30-year follow-up. nhlbi, 1987. 0 1 2 3 4 relative risk of chd mortality he j, et at. am heart j. 1999;138:211-219. copyright 1999, mosby inc. 112 151 98 (lowest 10%)(highest 10%) sbp (mmhg) dbp (mmhg) systolic blood pressure (sbp) diastolic

5、blood pressure (dbp) chd=coronary heart disease 0 1 2 3 4 5 6 7 8 9 relative risk of stroke death 112 151 98 (lowest 10%)(highest 10%) sbp (mmhg) dbp (mmhg) systolic blood pressure (sbp) diastolic blood pressure (dbp) he j, et at. am heart j. 1999;138:211-219. copyright 1999, mosby inc. 0 20 40 60 8

6、0 100 age-adjusted annual cvd event rate per 1000 wilking sv et al. jama. 1988;260:3451-3455. menwomen ish bp 160/95 mmhg bp 140/95 mmhg 82 43 33 2.4 18 2.5 cvd=cardiovascular disease ish=isolated systolic hypertension p0.001 for difference between both men and women with ish and blood pressure (bp)

7、 140/95 mmhg incidence of cardiovascular disease 120140160180200220 treatment effect systolic blood pressure (mmhg) 1967 va cooperative study on dbp 115-129 1970 va cooperative study on dbp 90-114 1979 hdfp 1980 australian trial, oslo trial 1985 mrc i, ewphe 1991 shep, stop-hypertension 1992 mrc ii

8、in the elderly 1997 syst-eur 2002 life 2002 allhat veterans administration, 1967 veterans administration, 1970 hypertension stroke study, 1974 usphs study, 1977 ewphe study, 1985 coope and warrender, 1986 shep study, 1991 stop-hypertension study, 1991 mrc study, 1992 syst-eur study, 1997 total odds

9、ratios and 95% confidence intervals 00.511.52 0.79 (0.69 to 0.90) he j, et al. am heart j. 1999; 138:211-219. copyright 1999, mosby, inc. active treatment better than placebo active treatment worse than placebo veterans administration, 1967 veterans administration, 1970 hypertension stroke study, 19

10、74 usphs study, 1977 ewphe study, 1985 coope and warrender, 1986 shep study, 1991 stop-hypertension study, 1991 mrc study, 1992 syst-eur study, 1997 total 00.511.52 0.63 (0.55 to 0.72) odds ratios and 95% confidence intervals active treatment better than placebo active treatment worse than placebohe

11、 j, et al. am heart j. 1999; 138:211-219. copyright 1999, mosby, inc. cohort143 men mean age51 years eligibilitydiastolic bp 115-129 mmhg designdouble blind; placebo control therapyhctz, reserpine, hydralazine duration1.5 years bp change-43/30 mmhg va cooperative study group. jama. 1967;202:1028-103

12、4. hctz=hydrochlorothiazide -1212 0 10 20 30 40 50 change in systolic bp (mmhg) percent of patients percent of patients change in diastolic bp (mmhg) 0 10 20 30 40 50 0 10 20 30 40 50 0 10 20 30 40 50 -76 -60 -44 -28028 decrease (-)(+) increase active drugs placebo active drugs placebo va cooperativ

13、e study group. jama. 1967;202:1028-1034. copyright 1967, american medical association. -1212-76 -60-44 -28028 decrease (-)(+) increase placebo n=70 active rx* n=73 accelerated hypertension120 stroke41 coronary event20 chf20 renal damage20 deaths40 va cooperative study group. jama. 1967;202:1028-1034

14、. *p0.001 active drug therapy vs placebo the actively treated group experienced a reduction in multiple hypertension-related endpoints 21 morbid/fatal events on placebo 1 morbid/fatal event on active therapy va cooperative study group. jama. 1967;202:1028-1034. cohort380 men mean age50 years eligibi

15、litydiastolic bp 90-114 mmhg designdouble blind; placebo control therapyhctz, reserpine, hydralazine duration5.5 years (mean=3.8 yrs) bp changediastolic bp -19 mmhg va cooperative study group. jama. 1970;213:1143-1152. accelerated hypertension40 stroke205 total coronary event1311 fatal coronary even

16、t116 congestive heart failure110 renal damage30 deaths198 va cooperative study group. jama. 1970;213:1143-1152. *p 60 yrs old; mean 72 yrs old eligibility systolic bp 150 239 mmhg; diastolic bp 90 119 mmhg designdouble blind; placebo control therapyhctz, triamterene duration4.7 years bp change-21/10

17、 mmhg at 5 years amery a, et al. lancet. 1985;1:1349-1354. 70 80 90 100 survival free of event (%) year of follow-up active (n=416) placebo (n=424) p=0.023 01362457 amery a, et al. lancet. 1985;1:1349-1354. reprinted with permission from elsevier science. ewphe=european working party on high blood p

18、ressure in the elderly active treatment reduced cardiovascular (cv) mortality, largely due to a reduction in cardiac mortality older patients (60 yrs old) with combined systolic and diastolic hypertension who received active therapy experienced 29 fewer cv events and 14 fewer cv deaths per 1,000 pat

19、ient-years of treatment amery a, et al. lancet. 1985;1:1349-1354. ewphe=european working party on high blood pressure in the elderly cohort10,940; 54% men; 44% black age30 69 yrs old; mean 50.8 yrs old eligibilitydiastolic bp 90 mmhg designstepped care vs referred care therapychlorthalidone (reserpi

20、ne, methyldopa) duration5 years bp change5 mmhg (stepped care vs referred care) hdfp cooperative group. jama. 1979;242:2562-2571. 0 2 4 6 8 cumulative mortality (%) 0136 year of follow-up entire cohort 245 referred care stepped care hdfp=hypertension detection and follow-up program *p0.01 hdfp coope

21、rative group. jama. 1979;242:2562-2571. (n=5,456) (n=5,485) * 0 2 4 6 8 0136245 cumulative mortality (%) diastolic bp 90 104 mmhg referred care stepped care hdfp=hypertension detection and follow-up program year of follow-up *p0.01 hdfp cooperative group. jama. 1979;242:2562-2571. (n=3,822) (n=3,903

22、) * bp=blood pressure overall, stepped care (sc) compared to referred care (rc) reduced total mortality by 17% (6.4 vs. 7.7%; p0.01) in patients with baseline diastolic blood pressure 90 104 mmhg (n=7,725), mortality was reduced by 20% with sc vs. rc (5.9% vs. 7.4%; p0.01) aggressive treatment of sc

23、 patients with the lowest baseline diastolic blood pressures (90 94 and 95 99 mmhg) reduced mortality hdfp=hypertension detection and follow-up program hdfp cooperative group. jama. 1979;242:2562-2571. shep research group. jama. 1991;265:3255-3264. cohort4,736; 43% men age 60 yrs old; mean 71.6 yrs

24、old eligibility systolic bp 160 219 mmhg and diastolic bp 90 mmhg designdouble blind; placebo control therapychlorthalidone (atenolol as step 2) duration4.5 years bp changesystolic bp 12 mmhg bp=blood pressure 65 70 75 80 140 150 160 170 180 change in bp (mmhg) years placebo (n=2,371) active rx (n=2

25、,365) years 012345012345 shep research group. jama. 1991;265:3255-3264. copyright 1991, american medical association. bp=blood pressure shep=systolic hypertension in the elderly program placebo (n=2,371) active rx (n=2,365) blood pressure (mmhg) 0123660 months of follow-up 2448 50 65 80 95 110 125 1

26、40 155 170 185 200 0 shep=systolic hypertension in the elderly program shep research group. jama. 1991;265:3255-3264. copyright 1991, american medical association. 0 1 2 3 4 5 6 7 8 9 10 cumulative stroke rate per 100 persons 0123660 months of follow-up 244872 p=0.0003 placebo (n=2,371) active rx (n

27、=2,365) shep=systolic hypertension in the elderly program shep research group. jama. 1991;265:3255-3264. copyright 1991, american medical association. 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 relative risk (95% ci) strokechd active therapy vs. placebo chfdeathcvd shep research group. jama. 1991;265:3

28、255-3264. shep=systolic hypertension in the elderly program chd=coronary heart disease; chf=congestive heart failure; cvd=cardiovascular disease shep was the first clinical trial to demonstrate that reduction of blood pressure in patients with isolated systolic hypertension reduced cardiovascular (c

29、v) mortality the relative risk of stroke was reduced by 36% with therapy compared to placebo (p=0.0003) the 5-year absolute benefits were a reduction in 30 strokes and 55 major cv disease events per 1,000 persons shep research group. jama. 1991;265:3255-3264. shep=systolic hypertension in the elderl

30、y program cohort4,695; 67% women age 60 yrs old eligibility systolic bp 160219 mmhg and diastolic bp 95 mmhg designdouble blind; placebo control therapynitrendipine (enalapril, hctz as step 2) durationmedian 2 yrs (1-97 months) bp difference -10/5 mmhg staessen ja, et al. lancet. 1997;350:757-764. 1

31、50 160 170 180 systolic bp (mmhg) 0 placebo (n=2,297) active treatment (n=2,398) 1234 years since randomization staessen ja, et al. lancet. 1997;350:757-764. reprinted with permission from elsevier science. syst-eur=systolic hypertension in europe trial p0.001 75 80 85 01234 diastolic bp (mmhg) plac

32、ebo (n=2,297) active treatment (n=2,398) p0.001 years since randomization staessen ja, et al. lancet. 1997;350:757-764. reprinted with permission from elsevier science. syst-eur=systolic hypertension in europe trial 0 1 2 3 4 5 6 events per 100 patients placebo (n=2,297) active treatment (n=2,398) 0

33、1342 p=0.003 years since randomization staessen ja, et al. lancet. 1997;350:757-764. reprinted with permission from elsevier science. syst-eur=systolic hypertension in europe trial -80 -60 -40 -20 0 20 percentage relative risk reduction (95% ci) strokemi active therapy vs. placebo chfdeath p=0.003 p

34、0.001 all cvd staessen ja, et al. lancet. 1997;350:757-764. mi=myocardial infarction; chf=congestive heart failure; cvd=cardiovascular disease syst-eur=systolic hypertension in europe trial older men and women with isolated systolic hypertension who received active treatment with a dihydropyridine c

35、alcium channel blocker experienced fewer strokes and cardiovascular disease (cvd) events than those receiving placebo. treatment of 1,000 patients for 5 years with this type of regimen could prevent 29 strokes or 53 major cvd endpoints. staessen ja, et al. lancet. 1997;350:757-764. syst-eur=systolic

36、 hypertension in europe trial the australian study committee. lancet. 1980;1:1261-1267. cohort3,427; 80% men age3069 yrs old eligibilitydiastolic bp 95109 mmhg designsingle blind; placebo control therapychlorothiazide (methyldopa, beta blocker) duration4 yrs bp difference -6 mmhg 80 84 88 92 96 100 104 at screeningduring trial placeboactive diastolic blood pressure (mmhg) the australian study committee. lancet. 1980;1:1261-1267. intention-