Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, Ducimetiere P, Benetos A
Department of Pharmacology and INSERM U 337, Broussais Hospital, Paris, France.
Hypertension. 2001 May;37(5):1236-41. doi: 10.1161/01.hyp.37.5.1236.
Although various studies reported that pulse pressure, an indirect index of arterial stiffening, was an independent risk factor for mortality, a direct relationship between arterial stiffness and all-cause and cardiovascular mortality remained to be established in patients with essential hypertension. A cohort of 1980 essential hypertensive patients who attended the outpatient hypertension clinic of Broussais Hospital between 1980 and 1996 and who had a measurement of arterial stiffness was studied. At entry, aortic stiffness was assessed from the measurement of carotid-femoral pulse-wave velocity (PWV). A logistic regression model was used to estimate the relative risk of all-cause and cardiovascular deaths. Selection of classic risk factors for adjustment of PWV was based on their influence on mortality in this cohort in univariate analysis. Mean age at entry was 50+/-13 years (mean+/-SD). During an average follow-up of 112+/-53 months, 107 fatal events occurred. Among them, 46 were of cardiovascular origin. PWV was significantly associated with all-cause and cardiovascular mortality in a univariate model of logistic regression analysis (odds ratio for 5 m/s PWV was 2.14 [95% confidence interval, 1.71 to 2.67, P<0.0001] and 2.35 [95% confidence interval, 1.76 to 3.14, P<0.0001], respectively). In multivariate models of logistic regression analysis, PWV was significantly associated with all-cause and cardiovascular mortality, independent of previous cardiovascular diseases, age, and diabetes. By contrast, pulse pressure was not significantly and independently associated to mortality. This study provides the first direct evidence that aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in patients with essential hypertension.
尽管多项研究报告称，作为动脉僵硬度间接指标的脉压是死亡率的独立危险因素，但在原发性高血压患者中，动脉僵硬度与全因死亡率和心血管死亡率之间的直接关系仍有待确定。对1980例原发性高血压患者进行了研究，这些患者于1980年至1996年间在布鲁赛医院门诊高血压诊所就诊，并测量了动脉僵硬度。入组时，通过测量颈股脉搏波速度（PWV）评估主动脉僵硬度。采用逻辑回归模型估计全因死亡和心血管死亡的相对风险。选择用于调整PWV的经典危险因素是基于它们在单变量分析中对该队列死亡率的影响。入组时的平均年龄为50±13岁（均值±标准差）。在平均112±53个月的随访期间，发生了107例致命事件。其中，46例源于心血管疾病。在逻辑回归分析的单变量模型中，PWV与全因死亡率和心血管死亡率显著相关（PWV为5 m/s时的比值比分别为2.14 [95%置信区间，1.71至2.67，P<0.0001]和2.35 [95%置信区间，1.76至3.14，P<0.0001]）。在逻辑回归分析的多变量模型中，PWV与全因死亡率和心血管死亡率显著相关，独立于既往心血管疾病、年龄和糖尿病。相比之下，脉压与死亡率无显著的独立相关性。本研究提供了首个直接证据，表明主动脉僵硬度是原发性高血压患者全因死亡率和心血管死亡率的独立预测因素。
