美国一项研究表明，单纯通过药物治疗维持正常血压具有重要影响，原因在于近半数实现指南推荐血压目标(收缩压<140 mmHg)的此类人群未能将卒中风险恢复至血压正常者水平。即便在降压治疗成功的情况下，通过预防和延迟高血压仍可能实现潜在增益。论文5月7日在线发表于《卒中》(Stroke)杂志。

        此项研究共纳入26875例年龄大于45岁的黑人和白人受试者，并对其新发卒中事件进行了评估和随访。将收缩压分类为正常(<120 mmHg)、高血压前期(120～139 mmHg)、1级高血压(140～159 mmHg)和2级高血压(>160 mmHg)。评估新发卒中与各类高血压和各类降压药数量的相关性。

        结果显示，在6.3年随访期间共发生823期卒中事件。近半数(46%)受试者高血压治疗成功(收缩压<140 mmHg)。在各层血压之中，卒中风险随需增加新一类降压药而升高;正常血压、高血压前期和1级高血压的危险比(HR)分别为1.33、1.15和1.22。

        对于通过3类以上降压药实现成功治疗(收缩压<120 mmHg)的高血压患者，其卒中风险稍高于未接受治疗的1级高血压患者;相对于未应用降压药且收缩压<120 mmHg的个体，二者的HR分别为2.48和2.19。

        参考文献：George Howard,et al. STROKEAHA.115.009128Published online before print May 7, 2015,doi: 10.1161/STROKEAHA.115.009128

Is Blood Pressure Control for Stroke Prevention the Correct Goal?
The Lost Opportunity of Preventing Hypertension
1. George Howard, DrPH,
2. Maciej Banach, MD, PhD,
3. Mary Cushman, MD,
4. David C. Goff, MD, PhD,
5. Virginia J. Howard, PhD,
6. Daniel T. Lackland, DrPH,
7. Jim McVay, DrPA,
8. James F. Meschia, MD,
9. Paul Muntner, PhD,
10. Suzanne Oparil, MD,
11. Melanie Rightmyer, DNP and
12. Herman A. Taylor, MD
+Author Affiliations
1. From the Departments of Biostatistics (G.H.) and Epidemiology (V.J.H., P.M.), UAB School of Public Health, Birmingham, AL; Department of Hypertension, Medical University of Lodz, Lodz, Poland (M.B.); Department of Medicine, University of Vermont, Burlington (M.C.); Office of the Dean, Colorado School of Public Health, Aurora, CO (D.C.G.); Department of Neurosciences, Medical University of South Carolina, Charleston (D.T.L.); Bureau of Health Promotion and Chronic Disease, Alabama Department of Public Health, Montgomery (J.M.V., M.R.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Medicine, UAB School of Medicine, Birmingham, AL (S.O.); and Department of Medicine, Morehouse School of Medicine, Atlanta, GA (H.A.T.).
1. Correspondence to George Howard, DrPH, Department of Biostatistics, UAB School of Public Health, 1665 University Blvd, Birmingham, AL. E-mail ghoward@uab.edu
Abstract
Background and Purpose—Although pharmacological treatment of hypertension has important health benefits, it does not capture the benefit of maintenance of ideal health through the prevention or delay of hypertension.
Methods—A total of 26 875 black and white participants aged 45+ years were assessed and followed for incident stroke events. The association was assessed between incident stroke and: (1) systolic blood pressure (SBP)categorized as normal (<120 mm Hg), prehypertension (120–139 mm Hg), stage 1 hypertension (140–159 mm Hg), and stage 2 hypertension (160 mm Hg+), and (2) number of classes of antihypertensive medications, classified as none, 1, 2, or 3 or more.
Results—During 6.3 years of follow-up, 823 stroke events occurred. Nearly half (46%) of the population were successfully treated (SBP<140 mm Hg) hypertensives. Within blood pressure strata, the risk of stroke increased with each additional class of required antihypertensive medication, with hazard ratio [HR], 1.33; 95% confidence interval, 1.16 to 1.52 for normotensive, HR, 1.15; 95% confidence interval, 1.05 to 1.26 for prehypertension, and HR, 1.22; 95% confidence interval, 1.06 to 1.39 for stage 1 hypertension. A successfully treated (SBP<120 mm Hg) hypertensive person on 3+ antihypertensive medication classes was at marginally higher stroke risk than a person with untreated stage 1 hypertension (HR, 2.48 versus HR=2.19; relative to those with SBP <120 on no antihypertensive medications).
Conclusions—Maintaining the normotensive status solely through pharmacological treatment has a profound impact, as nearly half of this general population cohort were treated to guideline (SBP<140 mm Hg) but failed to return to risk levels similar to normotensive individuals. Even with successful treatment, there is a substantial potential gain by prevention or delay of hypertension.