Background:This study aimed to evaluate the association of hypertension with incident infective endocarditis (IE) by investigating the incidence of IE according to blood pressure levels using the National Health Insurance Service database.Methods:The data of 4 080 331 individuals linked to the health screening database in 2009 were retrieved (males, 55.08%; mean age, 47.12±14.13 years). From 2009 to 2018, the risk factors for the first episode of IE were investigated. Hypertension was categorized into normotension, prehypertension, hypertension, and hypertension with medication. The Cox proportional hazard model assessed the effect of blood pressure level during the health screening exam on incident IE.Results:During the 9-year follow-up, 812 (0.02%) participants were diagnosed with IE. The incidence rates of IE in the normotension, prehypertension, hypertension, and hypertension with medication groups were 0.9, 1.4, 2.6, and 6.0 per 100 000 person-years, respectively. Those with prehypertension, hypertension, and hypertension with medication were correlated with an increased risk of IE in a dose-response manner compared with the normotension group (hazard ratio, 1.33 [95% CI, 1.06–1.68]; hazard ratio, 1.98 [1.48–2.66]; hazard ratio, 2.56 [2.02–3.24], respectively, all P<0.001).Conclusions:In a large national cohort study with an average follow-up of 9 years, increased blood pressure was identified as a risk factor for incident IE in a dose-dependent manner. Hypertension increases the public health care burden by acting as a risk factor for rare infective heart diseases.

中文翻译：

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高血压与感染性心内膜炎的关系

背景：本研究旨在通过使用国民健康保险服务数据库根据血压水平调查 IE 的发病率，评估高血压与偶发感染性心内膜炎 (IE) 的关系。方法：与健康相关的 4 080 331 个人的数据检索2009年筛查数据库（男性，55.08%；平均年龄，47.12±14.13岁）。从2009年到2018年，调查了首发IE的危险因素。高血压分为正常血压、高血压前期、高血压和药物性高血压。Cox 比例风险模型评估了健康检查期间血压水平对事件 IE 的影响。结果：在 9 年的随访期间，812 名（0.02%）参与者被诊断为 IE。IE在血压正常时的发生率，高血压前期、高血压和药物组高血压分别为 0.9、1.4、2.6 和 6.0/10 万人年。与正常血压组相比，高血压前期、高血压和药物高血压患者与 IE 风险增加呈剂量反应关系（风险比，1.33 [95% CI，1.06-1.68]；风险比，1.98 [1.48] –2.66]；风险比，分别为 2.56 [2.02–3.24]，所有P <0.001)。结论：在一项平均随访 9 年的大型国家队列研究中，血压升高被确定为 IE 事件的危险因素，且呈剂量依赖性。高血压作为罕见感染性心脏病的危险因素，增加了公共医疗保健负担。