Hypertension and cardiovascular disease, which may seem unrelated, actually have a close causal relationship between hypertension and the risk of cardiovascular disease onset and mortality. The two complement each other, as hypertension is a risk factor for cardiovascular disease, and cardiovascular disease can cause hypertension.
1. What is the relationship between blood pressure and cardiovascular risk?
Some findings found a continuous, independent and direct positive correlation between systolic blood pressure (SBP) or diastolic blood pressure (DBP) and the risk of stroke, coronary events, and cardiovascular death.
There was also a causal relationship between blood pressure levels and the development of heart failure, with long-term hypertension-left ventricular hypertrophy-heart failure constituting an important chain of events.
Clinical follow-up data show that the incidence of heart failure increases with increasing blood pressure levels, with heart failure and stroke being the two complications most closely associated with blood pressure levels. Hypertension primarily leads to heart failure with preserved ejection fraction; heart failure with reduced ejection fraction can also occur if combined with myocardial infarction in coronary artery disease.
In addition, hypertension is an important cause of the occurrence of atrial fibrillation, and hypertension-atrial fibrillation-cerebral embolism constitutes an important and easily overlooked chain of events.
Also, the relationship between office blood pressure levels and the aforementioned complications and cardiovascular disease has been confirmed in ambulatory blood pressure or home blood pressure monitoring studies. 24-hour ambulatory blood pressure levels, nighttime blood pressure levels, and early morning blood pressure levels, are even more strongly and significantly associated with cardiovascular and cerebrovascular disease risk. Recent studies have also shown that long-time blood pressure variability (BPV), which reflects the degree of fluctuation in blood pressure levels, may also be associated with cardiovascular risk.
2.What are the characteristics of cardiovascular risk in the hypertensive population in China?
China’s hypertensive population has a high risk of cardiovascular disease. According to the population surveillance data from the Chinese Guidelines for the Prevention and Treatment of Hypertension (2010 revision), cardiovascular and cerebrovascular disease deaths account for more than 40% of total deaths, with hypertension being the number one risk factor, and at least half of the 3 million cardiovascular deaths each year are related to hypertension.
Ischemic Stroke Chart
Cohort surveillance data also show that the annual incidence of stroke is 250/100,000 and the annual incidence of coronary events is 50/100,000, with the incidence of stroke five times higher than the incidence of coronary events.
And in clinical treatment trials, the incidence ratio of stroke/myocardial infarction was about (5-8):1 in our hypertensive population and about 1:1 in the Western hypertensive population.
Coronary heart disease graph
In recent years, the difference between the incidence of stroke and the incidence of coronary events has remained very pronounced, despite the upward trend in coronary events.
This suggests that stroke is the most important cardiovascular risk in our hypertensive population, and stroke prevention is an important goal in the treatment of hypertension in China, which is important for developing more effective prevention and treatment strategies to reduce cardiovascular risk in our population.
China has accumulated more experience in the prevention and treatment of cardiovascular disease.
Starting in the 1970s, China was the first to carry out population-based control of hypertension, which led to a significant reduction in stroke incidence and was recommended by the World Health Organization (WHO) as a model for developing countries in the 1990s.
References
[1] Revision Committee of the Chinese Guidelines for the Prevention and Treatment of Hypertension. Chinese guidelines for the prevention and treatment of hypertension (2010 revised edition) [J]. Chinese Journal of Practical Rural Physicians,2012,19(12):1-15.