Psaty B M, Furberg C D, Kuller L H, Borhani N O, Rautaharju P M, O'Leary D H, Bild D E, Robbins J, Fried L P, Reid C
Department of Medicine, University of Washington, Seattle 98105.
JAMA. 1992 Sep 9;268(10):1287-91.
To assess the association between isolated systolic hypertension (ISH) and subclinical disease in adults aged 65 years and above.
Medicare eligibility lists were used to obtain a representative sample of 5201 community-dwelling elderly persons for the Cardiovascular Health Study, a National Heart, Lung, and Blood Institute--sponsored cohort study of risk factors for coronary heart disease and stroke. In this cross-sectional analysis of baseline data, we excluded 3012 participants who were receiving antihypertensive medications, had clinical cardiovascular disease, or had a diastolic blood pressure of at least 90 mm Hg.
For electrocardiogram: myocardial infarction, left ventricular hypertrophy, and left ventricular mass as measures of myocardial damage and strain; for echocardiography: left ventricular mass, fractional shortening, and Doppler flow velocities as measures of cardiac systolic and diastolic function; and for carotid sonography: carotid arterial intima-media thickness as a measure of atherosclerosis.
Among the 2189 men and women in this analysis, 195 (9%) had ISH (systolic blood pressure, greater than or equal to 160 mm Hg) and 596 (23%) had borderline ISH (systolic blood pressure, 140 to 159 mm Hg). Systolic blood pressure was associated with myocardial infarction by electrocardiogram (P = .02). Borderline and definite ISH were strongly associated with left ventricular mass (P less than .001). While there was little association with cardiac systolic function, borderline and definite ISH were associated with cardiac diastolic function (P less than .001). Isolated systolic hypertension was also strongly associated with increased intima-media thickness of the carotid artery (P less than .001).
While cohort analyses of future repeated measures will provide a better assessment of risk, both borderline and definite ISH were strongly related to a variety of measures of subclinical disease in elderly men and women.
评估65岁及以上成年人单纯收缩期高血压（ISH）与亚临床疾病之间的关联。
利用医疗保险资格名单获取了5201名社区居住老年人的代表性样本，用于心血管健康研究，这是一项由美国国立心肺血液研究所资助的关于冠心病和中风危险因素的队列研究。在对基线数据的这项横断面分析中，我们排除了3012名正在接受抗高血压药物治疗、患有临床心血管疾病或舒张压至少为90毫米汞柱的参与者。
对于心电图：心肌梗死、左心室肥厚和左心室质量，作为心肌损伤和应变的指标；对于超声心动图：左心室质量、缩短分数和多普勒流速，作为心脏收缩和舒张功能的指标；对于颈动脉超声检查：颈动脉内膜中层厚度，作为动脉粥样硬化的指标。
在该分析中的2189名男性和女性中，195人（9%）患有ISH（收缩压大于或等于160毫米汞柱），596人（23%）患有临界ISH（收缩压为140至159毫米汞柱）。收缩压与心电图显示的心肌梗死相关（P = 0.02）。临界和确诊ISH与左心室质量密切相关（P < 0.001）。虽然与心脏收缩功能几乎没有关联，但临界和确诊ISH与心脏舒张功能相关（P < 0.001）。单纯收缩期高血压也与颈动脉内膜中层厚度增加密切相关（P < 0.001）。
虽然对未来重复测量的队列分析将提供更好的风险评估，但临界和确诊ISH均与老年男性和女性的多种亚临床疾病指标密切相关。
