主动脉僵硬度是原发性高血压患者致命性卒中的独立预测因素。

Aortic stiffness is an independent predictor of fatal stroke in essential hypertension.

作者信息

Laurent Stéphane, Katsahian Sandrine, Fassot Céline, Tropeano Anne-Isabelle, Gautier Isabelle, Laloux Brigitte, Boutouyrie Pierre

机构信息

Department of Pharmacology and INSERM EMI 0107, Hôpital Européen Georges Pompidou, Paris, France.

出版信息

Stroke. 2003 May;34(5):1203-6. doi: 10.1161/01.STR.0000065428.03209.64. Epub 2003 Apr 3.

DOI:10.1161/01.STR.0000065428.03209.64

PMID:12677025

Abstract

BACKGROUND AND PURPOSE

Pulse pressure is a stronger predictor of cardiovascular events than systolic or diastolic blood pressure in large cohorts of French and North American patients. However, its influence on stroke is controversial. Large-artery stiffness is the main determinant of pulse pressure. The influence of arterial stiffness on the occurrence of stroke has never been demonstrated. Our aim was to establish the relationship between aortic stiffness and stroke death in hypertensive patients.

METHODS

We included, in a longitudinal study, 1715 essential hypertensive patients who had a measurement of arterial stiffness at entry (ie, between 1980 and 2001) and no overt cardiovascular disease or symptoms. Mean follow-up was 7.9 years. At entry, aortic stiffness was assessed from the carotid-femoral pulse wave velocity. A Cox proportional hazard regression model was used to estimate the relative risk (RR) of stroke and coronary deaths.

RESULTS

Mean+/-SD age at entry was 51+/-13 years. Twenty-five fatal strokes and 35 fatal coronary events occurred. Pulse wave velocity significantly predicted the occurrence of stroke death in the whole population. There was a RR increase of 1.72 (95% CI, 1.48 to 1.96; P<0.0001) for each SD increase in pulse wave velocity (4 m/s). The predictive value of pulse wave velocity remained significant (RR=1.39 [95% CI, 1.08 to 1.72]; P=0.02) after full adjustment for classic cardiovascular risk factors, including age, cholesterol, diabetes, smoking, mean blood pressure, and pulse pressure. In this population, pulse pressure significantly predicted stroke in univariate analysis, with a RR increase of 1.33 (95% CI, 1.16 to 1.51) for each 10 mm Hg of pulse pressure (P<0.0001) but not after adjustment for age (RR=1.19 [95% CI, 0.96 to 1.47]; P=0.10).

CONCLUSIONS

This study provides the first evidence, in a longitudinal study, that aortic stiffness is an independent predictor of fatal stroke in patients with essential hypertension.

摘要

背景与目的

在大量法国和北美患者队列中，脉压比收缩压或舒张压更能预测心血管事件。然而，其对中风的影响存在争议。大动脉僵硬度是脉压的主要决定因素。动脉僵硬度对中风发生的影响尚未得到证实。我们的目的是确定高血压患者主动脉僵硬度与中风死亡之间的关系。

方法

在一项纵向研究中，我们纳入了1715例原发性高血压患者，这些患者在入组时（即1980年至2001年之间）测量了动脉僵硬度，且无明显心血管疾病或症状。平均随访7.9年。入组时，通过颈股脉搏波速度评估主动脉僵硬度。使用Cox比例风险回归模型估计中风和冠心病死亡的相对风险（RR）。

结果

入组时的平均年龄±标准差为51±13岁。发生了25例致命性中风和35例致命性冠心病事件。脉搏波速度显著预测了整个人群中风死亡的发生。脉搏波速度每增加1个标准差（4 m/s），RR增加1.72（95% CI，1.48至1.96；P<0.0001）。在对包括年龄、胆固醇、糖尿病、吸烟、平均血压和脉压在内的经典心血管危险因素进行全面调整后，脉搏波速度的预测价值仍然显著（RR=1.39 [95% CI，1.08至1.72]；P=0.02）。在该人群中，单因素分析中脉压显著预测中风，脉压每增加10 mmHg，RR增加1.33（95% CI，1.16至1.51）（P<0.0001），但在调整年龄后则无显著意义（RR=1.19 [95% CI，0.96至1.47]；P=0.10）。