심부전을 일으키는 고혈압, Predisposing hypertension for heart failure
교정 인자들 중에서 고혈압이 의심할 여지 없이 심부전의 가장 큰 기여 요인이며 모든 주된 심혈관 역학 연구에서 이것은 지속적으로 보였습니다.
Of the modifiable factors, hypertension undoubtedly contributes the greatest population attributable risk for heart failure. In other words, even though the increased risk for heart failure in an individual with hypertension is modest, the high prevalence of hypertension in the general population means that at a population level, hypertension is the major cause of heart failure.
The contribution of hypertension to the risk for heart failure was a consistent finding from all major cardiovascular epidemiologic studies, and the earliest RCTs of antihypertensive therapy showed unambiguous reductions in the risk for heart failure.
혈압의 구성 요소들 중에서 수축기 혈압 증가가 이완기 혈압보다 심부전에 더 큰 형양을 주었고, 사회 기반 연구에서 단독 수축기 혈압과 맥압 상승이 심부전 발생의 가장 예견적이었습니다.
Of the components of blood pressure, elevated systolic pressure has a greater influence on the incidence of heart failure than does diastolic pressure. In fact, aging is associated with a progressive rise in systolic blood pressure and fall in diastolic pressure as the compliance of the arterial tree diminishes. In community-based studies, isolated systolic hypertension and elevated pulse pressure have been the most predictive blood pressure measurements for development of heart failure. Antihypertensive treatment to a systolic blood pressure goal of 130 mm Hg appears to reduce the risk of developing heart failure. Reduction to lower than 120 mm Hg systolic provides additional benefit for reducing nonfatal cardiovascular events and all-cause mortality in patients without diabetes or prior heart failure, but at the cost of more hypotension, electrolyte abnormalities, and renal impairment. The current blood pressure goal is lower than 120 mm Hg for selected patients at high cardiovascular risk without diabetes or prior heart failure and lower than 130 mm Hg otherwise.
Framingham 연구에서 수축기 혈압과 맥압이 이완기 혈압보다 심부전 위험에 더 큰 영향을 주었습니다.
Another analysis from the Framingham study suggests that baseline systolic pressure and pulse pressure have a greater impact on the risk of subsequent HF than the diastolic pressure. In this analysis, 2040 participants ages 50 to 79 who were initially free of HF were followed for 17.4 years after baseline blood pressure measurements. Clinical evidence of HF developed in 234 subjects (11.8 percent). Increments of one standard deviation in systolic pressure, pulse pressure, and diastolic pressure were associated with hazard ratios for HF of 1.56, 1.55, and 1.24, respectively, after adjustment for other risk factors. The investigators hypothesize that increased arterial stiffness may be important in the influence of hypertension on the development of HF.
REF. UpToDate 2020.02.07
Goldman-Cecil Medicine, 26th medicine