Vaccarino V, Holford T R, Krumholz H M
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520-8034, USA.
J Am Coll Cardiol. 2000 Jul;36(1):130-8. doi: 10.1016/s0735-1097(00)00687-2.
We sought to determine whether pulse pressure (PP), a measure of arterial stiffness, is an independent predictor of the incidence of coronary heart disease (CHD), congestive heart failure (CHF) and overall mortality among community-dwelling elderly.
Current hypertension guidelines classify cardiovascular risk on the basis of elevated systolic blood pressure (SBP) or diastolic blood pressure (DBP) without considering their combined effects. Recent studies suggest that PP is a strong predictor of cardiovascular end points, but few data are available among community elderly.
The study sample included 2,152 individuals age > or =65 years, who were participants in the Established Populations for Epidemiologic Study of the Elderly program, free of CHD and CHF at baseline and still alive at one year after enrollment. Blood pressure was measured at baseline. Incidence of CHD, incidence of CHF and total mortality were monitored in the following 10 years.
There were 328 incident CHD events, 224 incident CHF events and 1,046 persons who died of any cause. Pulse pressure showed a strong and linear relationship with each end point. After adjusting for demographics, comorbidity and CHD risk factors, a 10-mm Hg increment in PP was associated with a 12% increase in CHD risk (95% confidence interval [CI], 2% to 22%), a 14% increase in CHF risk (95% CI, 5% to 24%), and a 6% increase in overall mortality (95% CI, 0% to 12%). While SBP and mean arterial pressure (MAP) also showed positive associations with the end points, PP yielded the highest likelihood ratio chi-square. When PP was entered in the model in conjunction with other blood pressure parameters (SBP, DBP, MAP or hypertension stage, respectively), the association remained positive for PP but became negative for the other blood pressure variables. The effect of PP persisted after adjusting for current medication use and was present in normotensive individuals and individuals with isolated systolic hypertension but not in individuals with diastolic hypertension.
Elevated PP is a powerful independent predictor of cardiovascular end points in the elderly.
我们试图确定脉压（PP）这一动脉僵硬度指标是否为社区老年人群冠心病（CHD）、充血性心力衰竭（CHF）发病率及全因死亡率的独立预测因素。
当前高血压指南依据收缩压（SBP）或舒张压（DBP）升高来分类心血管风险，而未考虑其联合效应。近期研究表明PP是心血管终点的强预测因素，但社区老年人中的相关数据较少。
研究样本包括2152名年龄≥65岁的个体，他们是老年流行病学研究既定人群项目的参与者，基线时无CHD和CHF且入组一年后仍存活。在基线时测量血压。在接下来的10年中监测CHD发病率、CHF发病率和全因死亡率。
发生328例CHD事件、224例CHF事件，1046人死于任何原因。脉压与每个终点均呈现强线性关系。在调整人口统计学、合并症和CHD危险因素后，PP每增加10 mmHg，CHD风险增加12%（95%置信区间[CI]，2%至22%），CHF风险增加14%（95%CI，5%至24%），全因死亡率增加6%（95%CI，0%至12%）。虽然SBP和平均动脉压（MAP）也与终点呈现正相关，但PP产生的似然比卡方值最高。当PP与其他血压参数（分别为SBP、DBP、MAP或高血压分期）一同纳入模型时，PP的关联仍为阳性，而其他血压变量的关联变为阴性。在调整当前用药情况后，PP的效应依然存在，且在血压正常个体和单纯收缩期高血压个体中存在，但在舒张期高血压个体中不存在。
PP升高是老年人心血管终点的有力独立预测因素。
