Psaty B M, Furberg C D, Kuller L H, Cushman M, Savage P J, Levine D, O'Leary D H, Bryan R N, Anderson M, Lumley T
Cardiovascular Health Study, Coordinating Center, Plaza 600 Building, Seattle, WA 98101, USA.
Arch Intern Med. 2001 May 14;161(9):1183-92. doi: 10.1001/archinte.161.9.1183.
Recent reports have drawn attention to the importance of pulse pressure as a predictor of cardiovascular events. Pulse pressure is used neither by clinicians nor by guidelines to define treatable levels of blood pressure.
In the Cardiovascular Health Study, 5888 adults 65 years and older were recruited from 4 US centers. At baseline in 1989-1990, participants underwent an extensive examination, and all subsequent cardiovascular events were ascertained and classified.
At baseline, 1961 men and 2941 women were at risk for an incident myocardial infarction or stroke. During follow-up that averaged 6.7 years, 572 subjects had a coronary event, 385 had a stroke, and 896 died. After adjustment for potential confounders, systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure were directly associated with the risk of incident myocardial infarction and stroke. Only SBP was associated with total mortality. Importantly, SBP was a better predictor of cardiovascular events than DBP or pulse pressure. In the adjusted model for myocardial infarction, a 1-SD change in SBP, DBP, and pulse pressure was associated with hazard ratios (95% confidence intervals) of 1.24 (1.15-1.35), 1.13 (1.04-1.22), and 1.21 (1.12-1.31), respectively; and adding pulse pressure or DBP to the model did not improve the fit. For stroke, the hazard ratios (95% confidence intervals) were 1.34 (1.21-1.47) with SBP, 1.29 (1.17-1.42) with DBP, and 1.21 (1.10-1.34) with pulse pressure. The association between blood pressure level and cardiovascular disease risk was generally linear; specifically, there was no evidence of a J-shaped relationship. In those with treated hypertension, the hazard ratios for the association of SBP with the risks for myocardial infarction and stroke were less pronounced than in those without treated hypertension.
In this population-based study of older adults, although all measures of blood pressure were strongly and directly related to the risk of coronary and cerebrovascular events, SBP was the best single predictor of cardiovascular events.
近期报告已使人们关注脉压作为心血管事件预测指标的重要性。临床医生和指南均未使用脉压来定义可治疗的血压水平。
在心血管健康研究中，从美国4个中心招募了5888名65岁及以上的成年人。在1989 - 1990年的基线期，参与者接受了全面检查，并确定和分类了所有后续的心血管事件。
在基线期，1961名男性和2941名女性有发生心肌梗死或中风的风险。在平均6.7年的随访期间，572名受试者发生了冠状动脉事件，385名发生了中风，896人死亡。在对潜在混杂因素进行调整后，收缩压（SBP）、舒张压（DBP）和脉压与发生心肌梗死和中风的风险直接相关。只有收缩压与总死亡率相关。重要的是，收缩压比舒张压或脉压更能预测心血管事件。在心肌梗死的校正模型中，收缩压、舒张压和脉压每变化1个标准差，对应的风险比（95%置信区间）分别为1.24（1.15 - 1.35）、1.13（1.04 - 1.22）和1.21（1.12 - 1.31）；将脉压或舒张压纳入模型并不能改善拟合效果。对于中风，收缩压、舒张压和脉压对应的风险比（95%置信区间）分别为1.34（1.21 - 1.47）、1.29（1.17 - 1.42）和1.21（1.10 - 1.34）。血压水平与心血管疾病风险之间的关联通常呈线性；具体而言，没有证据表明存在J形关系。在接受高血压治疗的人群中，收缩压与心肌梗死和中风风险的关联风险比不如未接受高血压治疗的人群明显。
在这项基于人群的老年人研究中，尽管所有血压测量指标都与冠状动脉和脑血管事件风险密切且直接相关，但收缩压是心血管事件的最佳单一预测指标。
