血压与心血管死亡的关系：脉压对老年人的影响。

Relationship of blood pressure to cardiovascular death: the effects of pulse pressure in the elderly.

作者信息

Lee M L, Rosner B A, Weiss S T

机构信息

Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.

出版信息

Ann Epidemiol. 1999 Feb;9(2):101-7. doi: 10.1016/s1047-2797(98)00034-9.

DOI:10.1016/s1047-2797(98)00034-9

PMID:10037553

Abstract

PURPOSE

To investigate the relationship of systolic and diastolic blood pressure to fatal myocardial infarction, fatal stroke and other death related to cardiovascular diseases (CVD).

METHODS

The study was based on a prospective longitudinal study conducted by the Veterans Administration at the Boston Outpatient Clinic. Participants are male volunteers from the greater Boston area. Main outcome measures are fatal myocardial infarction, fatal stroke and other deaths related to cardiovascular diseases. The method of pooled logistic regression was used for statistical analysis.

RESULTS

For younger men (age 21-59), after adjusting for effects of other risk factors, when systolic and diastolic blood pressure were considered separately, SBP was predictive of cardiovascular death (SBP: RR = 1.23; 95% CI = (1.05, 1.45) per 10 mmHg of increase), and DBP showed a nonsignificant positive trend in relation to cardiovascular death (DBP: RR = 1.27; 95% CI = (0.95, 1.69) per 10 mmHg of increase). For older men (age 60-85), when SBP and DBP were considered separately, SBP (RR = 1.26; 95% CI = (1.02, 1.55) per 15 mmHg of increase) was directly related, but DBP (RR = 1.05; 95% CI = (0.83, 1.32) per 8 mmHg of increase) was not related to cardiovascular death. However, for the elderly group, when SBP and DBP were considered jointly in the regression model, then the regression coefficient of DBP (beta = -0.018, p = 0.30) was of approximately the same absolute magnitude as that of SBP (beta = 0.021, p = 0.02) but opposite in sign. For younger men, when SBP and DBP were considered jointly, SBP (beta = 0.021, p = 0.049) but not DBP (beta = -0.001, p = 0.953) was positively related to cardiovascular death.

CONCLUSIONS

We found that, for the elderly, pulse pressure (SBP-DBP) may be a more accurate predictor of cardiovascular death than either SBP or DBP alone. The relative risk per 35 mmHg of increase of pulse pressure, which equals the approximate interval from the 10th to the 90th percentile in the elderly group, is 2.1 with 95% CI = (1.1, 3.8). In younger subjects, SBP, but not DBP, is an independent predictor of fatal CVD.

摘要

目的

研究收缩压和舒张压与致命性心肌梗死、致命性中风及其他心血管疾病（CVD）相关死亡之间的关系。

方法

本研究基于退伍军人管理局在波士顿门诊诊所进行的一项前瞻性纵向研究。参与者为大波士顿地区的男性志愿者。主要结局指标为致命性心肌梗死、致命性中风及其他心血管疾病相关死亡。采用合并逻辑回归方法进行统计分析。

结果

对于较年轻男性（21 - 59岁），在调整其他危险因素的影响后，当分别考虑收缩压和舒张压时，收缩压可预测心血管死亡（收缩压：每升高10 mmHg，RR = 1.23；95% CI = (1.05, 1.45)），舒张压与心血管死亡呈非显著的正相关趋势（舒张压：每升高10 mmHg，RR = 1.27；95% CI = (0.95, 1.69)）。对于较年长男性（60 - 85岁），当分别考虑收缩压和舒张压时，收缩压（每升高15 mmHg，RR = 1.26；95% CI = (1.02, 1.55)）与心血管死亡直接相关，但舒张压（每升高8 mmHg，RR = 1.05；95% CI = (0.83, 1.32)）与心血管死亡无关。然而，对于老年组，当在回归模型中联合考虑收缩压和舒张压时，舒张压的回归系数（β = -0.018，p = 0.30）与收缩压的回归系数（β = 0.021，p = 0.02）绝对值大致相同，但符号相反。对于较年轻男性，当联合考虑收缩压和舒张压时，收缩压（β = 0.021，p = 0.049）与心血管死亡呈正相关，而舒张压（β = -0.001，p = 0.953）与心血管死亡无关。

结论

我们发现，对于老年人，脉压（收缩压 - 舒张压）可能比单独的收缩压或舒张压更准确地预测心血管死亡。脉压每升高35 mmHg的相对风险为2.1，95% CI = (1.1, 3.8)，这相当于老年组中约第10百分位数到第90百分位数的区间。在较年轻受试者中，收缩压而非舒张压是致命性CVD的独立预测因素。