Glynn R J, Chae C U, Guralnik J M, Taylor J O, Hennekens C H
Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave E, Boston, MA 02215, USA.
Arch Intern Med. 2000 Oct 9;160(18):2765-72. doi: 10.1001/archinte.160.18.2765.
In older people, observational data are unclear concerning the relationships of systolic and diastolic blood pressure with cardiovascular and total mortality. We examined which combinations of systolic, diastolic, pulse, and mean arterial pressure best predict total and cardiovascular mortality in older adults.
In 1981, the National Institute on Aging initiated its population-based Established Populations for Epidemiologic Studies of the Elderly in 3 communities. At baseline, 9431 participants, aged 65 to 102 years, had blood pressure measurements, along with measures of medical history, use of medications, disability, and physical function. During an average follow-up of 10. 6 years among survivors, 4528 participants died, 2304 of cardiovascular causes.
In age- and sex-adjusted survival analyses, the lowest overall death rate occurred among those with systolic pressure less than 130 mm Hg and diastolic pressure 80 to 89 mm Hg; relative to this group, the highest death rate occurred in those with systolic pressure of 160 mm Hg or more and diastolic pressure less than 70 mm Hg (relative risk, 1.90; 95% confidence interval, 1.47-2.46). Both low diastolic pressure and elevated systolic pressure independently predicted increases in cardiovascular (P<.001) and total (P<.001) mortality. Pulse pressure correlated strongly with systolic pressure (R = 0.82) but was a slightly stronger predictor of both cardiovascular and total mortality. In a model containing pulse pressure and other potentially confounding variables, diastolic pressure (P =.88) and mean arterial pressure (P =.11) had no significant association with mortality.
Pulse pressure appears to be the best single measure of blood pressure in predicting mortality in older people and helps explain apparently discrepant results for low diastolic blood pressure.
在老年人中，关于收缩压和舒张压与心血管疾病及全因死亡率之间的关系，观察性数据尚不明确。我们研究了收缩压、舒张压、脉压和平均动脉压的哪些组合能最好地预测老年人的全因死亡率和心血管疾病死亡率。
1981年，美国国立衰老研究所启动了基于人群的老年人流行病学研究既定人群项目，涉及3个社区。在基线时，9431名年龄在65至102岁的参与者进行了血压测量，同时还测量了病史、药物使用情况、残疾状况和身体功能。在幸存者平均10.6年的随访期间，4528名参与者死亡，其中2304人死于心血管疾病。
在年龄和性别调整的生存分析中，收缩压低于130mmHg且舒张压为80至89mmHg的人群总体死亡率最低；相对于该组，收缩压为160mmHg或更高且舒张压低于70mmHg的人群死亡率最高（相对风险，1.90；95%置信区间，1.47 - 2.46）。低舒张压和收缩压升高均独立预测心血管疾病（P<0.001）和全因（P<0.001）死亡率增加。脉压与收缩压密切相关（R = 0.82），但对心血管疾病和全因死亡率的预测作用略强。在包含脉压和其他潜在混杂变量的模型中，舒张压（P = 0.88）和平均动脉压（P = 0.11）与死亡率无显著关联。
脉压似乎是预测老年人死亡率的最佳单一血压指标，有助于解释低舒张压时明显矛盾的结果。
