关键词: 高血压, 疾病管理, 心脑血管疾病, 前瞻性研究

Abstract: Background　Hypertension is a risk factor for new-onset cardio-cerebrovascular diseases in the general population. At present，most studies focus on whether attaining the target blood pressure level has an influence on the morbidity of newly developed cardio-cerebrovascular diseases in hypertensive patients. There is no research on the association of times of attaining the target blood pressure level and cardio-cerebrovascular disease incidence in patients with hypertension. Objective　To evaluate the association of times of attaining the target blood pressure level with cardio-cerebrovascular disease morbidity in hypertensive patients. Methods　A prospective cohort study design was applied. A total of 16 131 hypertensive participants who participated in four annual health examinations（2006，2008，2010，2012） conducted by Kailuan（Group） Limited Liability Corporation and had no history of cardio-cerebrovascular diseases and cancer were enrolled. The follow-up started from the completion of the 2012 annual health examination，and ended till the onset of newly diagnosed cardio-cerebrovascular disease，death or the last day of follow-up period（2017-12-31）. For ease of estimating the association of times of attaining the target blood pressure level with cardio-cerebrovascular disease incidence，those who were found with attaining the target blood pressure level for 0，1，2，and 3 times in 2008，2010，and 2012 annual examinations were assigned to zero-time（n=5 850），one-time（n=4 838），two-time （n=3 276），and three-time（n=2 167） groups，respectively，and baseline data and incidence of cardio-cerebrovascular disease were compared between the groups. The cumulative incidence was estimated by Kaplan-Meier approach，and was compared by Log-Rank test. Multivariate Cox regression model was used to analyze the effect of the times of attaining the target blood pressure level on the incidence of cardio-cerebrovascular diseases. After excluding those with diabetes，hyperlipidemia and smoking habit，the Cox regression model was analyzed for sensitivity analysis. Results　There were significant differences in average age，male proportion，SBP，DBP，FBG，TC，and hs-CRP，proportion of smokers，proportion of drinkers，proportion of physical exercisers，detection rate of diabetes，detection rate of hyperlipidemia，and proportions of people taking antihypertensive drugs and hypoglycemic drugs among the groups（P<0.05）. The average follow-up period was （4.61±0.80） years. The incidence rate of CVD was 102.40/10 000 years. The cumulative incidence of cardio-cerebrovascular disease for zero-time，one-time，two-time，and three-time groups was 7.5%，6.9%，3.4% and 1.9%，respectively. And Log-Rank test showed that the difference in cumulative incidence of cardio-cerebrovascular disease among the groups was significant（χ2=128.33，P<0.01）. The Cox regression analysis presented that after adjusting for age，gender，BMI，hs-CRP，hyperlipidemia，diabetes，history of taking antihypertensive drugs，smoking，drinking，and physical exercise，compared with zero-time group，the HR（95%CI） for cardio-cerebrovascular disease incidence in one-time，two-time，and three-time groups was 0.90（0.76，1.06），0.53（0.42，0.68）and 0.37（0.26，0.53），respectively. The above results were not changed after excluding the diabetic，smoking and hyperlipidemia participants in the sensitivity analysis. Conclusion　 More times of attaining the target blood pressure level may be a protective factor for cardio-cerebrovascular disease，and continuous attaining the target may be associated with decreased risk of cardio-cerebrovascular disease.

Key words: Hypertension, Disease management, Cardiovascular diseases, Prospective studies