Mason Peter J, Manson JoAnn E, Sesso Howard D, Albert Christine M, Chown Marilyn J, Cook Nancy R, Greenland Philip, Ridker Paul M, Glynn Robert J
Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02215-1204, USA.
Circulation. 2004 Apr 6;109(13):1623-9. doi: 10.1161/01.CIR.0000124488.06377.77. Epub 2004 Mar 15.
In apparently healthy people, the relation between blood pressure and risk of subsequent cardiovascular disease (CVD) is linear. In persons with CVD, the relation is uncertain.
We conducted a prospective study of 5218 older women with CVD who reported their blood pressure at baseline in the Women's Antioxidant Cardiovascular Study (WACS), an ongoing double-blind, placebo-controlled secondary prevention trial of the benefits and risks of antioxidant vitamins, folic acid, vitamin B6, and vitamin B12 among women with CVD or > or =3 coronary risk factors. A total of 661 confirmed CVD events (nonfatal myocardial infarction, nonfatal stroke, coronary artery bypass graft procedure, percutaneous coronary angioplasty, or CVD death) occurred during a median follow-up of 6.5 years. After controlling for age, randomized treatment assignment, antihypertensive medication use, and coronary risk factors, we found that systolic blood pressure (SBP) was a strong predictor of CVD events and that the relation between SBP and CVD risk was positive, continuous, and linear (P for linear trend=0.001). For each 10-mm Hg increment in SBP, there was a 9% (95% CI 4% to 15%) increase in risk of secondary CVD events. Diastolic blood pressure, mean arterial pressure, and pulse pressure were weaker predictors of CVD risk in this cohort, and joint consideration of SBP and diastolic blood pressure found that only SBP significantly predicted risk. Use of antihypertensive medication did not modify the relationship of SBP with CVD events.
In this population of women with CVD, we observed a strong, continuous, and linear association between SBP and risk of secondary CVD events. SBP was the blood pressure measure most strongly related to CVD risk.
在表面健康的人群中，血压与随后发生心血管疾病（CVD）风险之间的关系呈线性。在患有CVD的人群中，这种关系尚不确定。
我们对5218名患有CVD的老年女性进行了一项前瞻性研究，这些女性在女性抗氧化剂心血管研究（WACS）中报告了她们的基线血压，WACS是一项正在进行的双盲、安慰剂对照的二级预防试验，研究抗氧化剂维生素、叶酸、维生素B6和维生素B12对患有CVD或有≥3个冠心病危险因素的女性的益处和风险。在中位随访6.5年期间，共发生661例确诊的CVD事件（非致命性心肌梗死、非致命性中风、冠状动脉搭桥手术、经皮冠状动脉腔内血管成形术或CVD死亡）。在控制年龄、随机治疗分配、抗高血压药物使用和冠心病危险因素后，我们发现收缩压（SBP）是CVD事件的强预测因子，且SBP与CVD风险之间的关系是正性、连续和线性的（线性趋势P=0.001）。SBP每升高10 mmHg，继发性CVD事件风险增加9%（95%CI 4%至15%）。在该队列中，舒张压、平均动脉压和脉压是CVD风险的较弱预测因子，同时考虑SBP和舒张压发现只有SBP能显著预测风险。使用抗高血压药物并未改变SBP与CVD事件之间的关系。
在这群患有CVD的女性中，我们观察到SBP与继发性CVD事件风险之间存在强的、连续的和线性的关联。SBP是与CVD风险最密切相关血压指标。
