Nawrot T S, Staessen J A, Thijs L, Fagard R H, Tikhonoff V, Wang J-G, Franklin S S
Studiecoördinatiecentrum, Laboratorium hypertensie, Departement Moleculair en Cardiovasculair Onderzoek, Katholieke Universiteit Leuven, Leuven, Belgium.
J Hum Hypertens. 2004 Apr;18(4):279-86. doi: 10.1038/sj.jhh.1001669.
An increased pulse pressure suggests aortic stiffening. New evidence also suggests that pulse pressure is a more sensitive measure of risk than other indexes of blood pressure in middle-aged and older persons. The objective of the study was to relate pulse pressure to the risk of cardiovascular events in the general population, and to assess whether pulse pressure could improve the Framingham risk prediction. A total of 378 men and 391 women over the age of 50 years (mean 62.7 years) were followed. Sex-specific Framingham cardiovascular risk scores were derived from age, systolic pressure, diastolic pressure, total and HDL cholesterol, smoking status and the presence or absence of diabetes mellitus. The cutoff points used to develop a pulse pressure score were calculated by determining the percentile points corresponding to the blood pressure categories in the Framingham risk score. We calculated relative hazard rates by multiple Cox regression. After a median follow-up of 7.2 years (range: 11 months-15 years), a total of 148 cardiovascular events occurred. In Cox regression analysis, a 10 mmHg higher pulse pressure was associated with 31% (P<0.0001) increase in the risk for cardiovascular events (fatal and nonfatal) after adjustment for sex, age, total and HDL cholesterol, smoking and the presence of diabetes mellitus. After adjustment for the aforementioned risk factors, a one-point increment in the blood pressure and pulse pressure scores was associated with a 40 and 48% (both P<0.0001) increase in the risk of fatal and nonfatal cardiovascular events, respectively. When both the blood pressure and pulse pressure scores were forced into a Cox model, only the pulse pressure score remained statistically significant (P<0.0001) with a relative hazard rate of 1.37 (CI: 1.16-1.69). These prospective data suggest that pulse pressure may improve the Framingham risk prediction among middle-aged and older individuals. Further studies, especially in the Framingham cohort, are warranted.
脉压升高提示主动脉僵硬度增加。新证据还表明，在中老年人中，脉压比其他血压指标是更敏感的风险衡量指标。本研究的目的是探讨脉压与普通人群心血管事件风险的关系，并评估脉压是否能改善弗明汉姆风险预测。对378名男性和391名50岁以上（平均62.7岁）的女性进行了随访。根据年龄、收缩压、舒张压、总胆固醇和高密度脂蛋白胆固醇、吸烟状况以及是否患有糖尿病得出特定性别的弗明汉姆心血管风险评分。通过确定与弗明汉姆风险评分中的血压类别相对应的百分位数来计算用于制定脉压评分的切点。我们通过多因素Cox回归计算相对风险率。在中位随访7.2年（范围：11个月至15年）后，共发生148例心血管事件。在Cox回归分析中，调整性别、年龄、总胆固醇和高密度脂蛋白胆固醇、吸烟以及是否患有糖尿病后，脉压每升高10 mmHg，心血管事件（致命和非致命）风险增加31%（P<0.0001）。调整上述风险因素后，血压和脉压评分每增加1分，致命和非致命心血管事件风险分别增加40%和48%（均P<0.0001）。当将血压和脉压评分都纳入Cox模型时，只有脉压评分仍具有统计学意义（P<0.0001），相对风险率为1.37（CI：1.16 - 1.69）。这些前瞻性数据表明，脉压可能改善中老年人的弗明汉姆风险预测。有必要进行进一步研究，尤其是在弗明汉姆队列中。
