高血压与冠心病医学课件.ppt

* Perhaps most striking are the practical implications of these data: even a small, 2–mm Hg fall in mean systolic BP would be associated with large absolute reductions in premature deaths and disabling strokes.1 As shown here, a 2 mm Hg lower mean systolic BP could lead to a 7% lower risk of death from ischemic heart disease (IHD) and a 10% lower risk of stroke death1 Data from a meta-analysis of 61 prospective observational studies provide powerful evidence that throughout middle and old age, BP is strongly and directly related to vascular mortality.1 For example, a 10 mm Hg lower systolic BP is associated over the long term with a 40% lower risk of stroke death and a 30% lower risk of death from IHD or other vascular causes1 Within each decade of life between years 40 and 89, the proportional difference in the risk of vascular death associated with a given absolute difference in mean BP is roughly equivalent down to at least 115 mm Hg for systolic BP and 75 mm Hg for diastolic BP (below this level, there is little evidence). Thus, there was no evidence of a J curve across all middle and older age groups1 The investigators included studies in which data on blood pressure, blood cholesterol, date of birth (or age), and sex had been recorded at baseline and in which a cause and date of death had been sought by study screeners. 33 of the studies were done in Europe (eg, the British Regional Heart Study, the Scottish Heart Health Study, the Tromso Study, assessing the association between blood pressure and serum lipids), 18 in North America or Australia (eg, the Atherosclerosis Risk in Communities Study, the Minnesota Heart Health Program), and 10 in China or Japan (eg, the Seven Cities China study on stroke prevention)1 Reference Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, for the Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prosp