关键词: 心血管疾病, 原发性高血压, 危险分层, 理想心血管健康, 影响因素分析

Abstract: Background　Dyslipidemia，primary hypertension，diabetes，obesity，smoking，unhealthy diet and lack of physical activity are risk factors that can be changed for atherosclerotic cardiovascular diseases（ASCVD），which are used to assess 10-year risk of ASCVD. Maintaining the four behavioral factors，three physiological and biochemical parameters above in an ideal state can significantly reduce the incidence of ASCVD in the population. Objective　To analyze the level of risk factors，risk stratification，ideal cardiovascular health behaviors and factors of ASCVD in outpatient patients with primary hypertension and to comprehensively reflect the risk of ASCVD. Methods　Three thousand four hundred and fifty-one patients with primary hypertension and aged over 35 years old who were treated in Beijing Anzhen Hospital，Capital Medical University from June 2016 to June 2017 were enrolled as the research objects. The basic information of the patients was collected by face-to-face inquiry，on-site measurement and blood biochemical tests. The 10-year risk assessment and prediction model of ASCVD（hereinafter referred to as prediction tool method）proposed by Professor Wu Yangfeng and the method provided by the Chinese guidelines for cardiovascular disease prevention（hereinafter referred to as the guideline method）were used for risk evaluation of ASCVD and risk stratification. The definition of ideal cardiovascular health is based on the recommendations of the American Heart Association（AHA）（including 7 ideal health factors and behaviors）. The Kappa value was calculated，and the consistency of the two methods in the risk stratification of ASCVD was evaluated. Results　For patients with primary hypertension and aged ≥55 years old，there was significant difference in the proportions of different populations at risk of ASCVD judged by the two methods（χ2=10.608，P=0.005），and the proportion of high-risk ASCVD judged by the prediction model was higher than that preliminarily judged by the guideline method（χ2=4.219，P=0.04）. For the patients with primary hypertension aged <55 years old，there was significant difference in the proportions of different populations at risk of ASCVD judged by the two methods（χ2=534.350，P<0.001）；low-risk population（76.3%）was prominent judged by the prediction model，and the proportion of high-risk population was only 6.6%，in contrast，the proportion of high-risk population primarily judged by the guideline method was up to 29.5%. When the risk throughout the life was evaluated，66 patients（13.0%）were adjusted to be high-risk，and the final proportion of high-risk patients reached 34.5%. For patients judged to be low-risk，moderate-risk and high-risk by the prediction model method，the proportion of low-risk，moderate-risk and high-risk patients assessed by the guideline method was 51.9%，44.5% and 56.0%，respectively，with a consistency rate of 50.8%. Through the internal consistency test，the Kappa value was 0.261（u=17.010，P<0.001）. Only 2.4% of the patients had 5 healthy behaviors and factors，and 70.4% had 2-3 healthy behaviors and factors. The proportion of female primary hypertension patients with non-smoking/quitting smoking，ideal BMI，FPG<5.6 mmol / L and blood pressure<120/80 mm Hg was higher than that in males，and the proportion of TC<5.2 mmol/L was lower than that in males；there were also significant difference in the proportion of ideal physical activity and cardiovascular health parameters in patients with primary hypertension of different genders（P<0.05）. The proportion of female patients with normal cardiovascular health parameters ≥1，≥ 2，≥ 3 and ≥ 4 was higher than that in males（χ2=33.980，P<0.001；χ2=34.946，P<0.001；χ2=107.419，P<0.001；χ2=37.488，P<0.001）. Conclusion　The internal consistency of the two evaluation methods is poor. For patients with primary hypertension and aged<55 years old，the proportion of high-risk patients determined by the guidelines is also more than 1/3，which is close to the proportion of high-risk patients aged ≥ 55 years old，thus the risk of ASCVD may be overestimated in this population. For 5 cardiovascular healthy behaviors and factors，about 70% of the patients with have 2-3 healthy behaviors and factors. Control of risk factors in patients with primary hypertension and improvement of cardiovascular health may be important strategies to reduce the risk of ASCVD.

Key words: Cardiovascular disease, Primary hypertension, Risk stratification, Ideal cardiovascular health, Root cause analysis