Jankowski Piotr, Kawecka-Jaszcz Kalina, Czarnecka Danuta, Brzozowska-Kiszka Malgorzata, Styczkiewicz Katarzyna, Loster Magdalena, Kloch-Badełek Małgorzata, Wiliński Jerzy, Curyło Adam M, Dudek Dariusz
I Department of Cardiology and Hypertension, Collegium Medicum Jagiellonian University, Kraków, Poland.
Hypertension. 2008 Apr;51(4):848-55. doi: 10.1161/HYPERTENSIONAHA.107.101725. Epub 2008 Feb 11.
Although the differences between central and peripheral blood pressure (BP) values have been known for decades, the consequences of decision making based on peripheral rather than central BP have only recently been recognized. There are only a few studies assessing the relationship between intraaortic BP and cardiovascular risk. In addition, the relationship between central BP and the risk of cardiovascular events in a large group of coronary patients has not yet been evaluated. Therefore, the aim of the study was to determine the prognostic significance of central BP-derived indices in patients undergoing coronary angiography. Invasive central BPs were taken at baseline, and study end points were ascertained during over a 4.5-year follow-up in 1109 consecutive patients. The primary end point (cardiovascular death or myocardial infarction or stroke or cardiac arrest or heart transplantation or myocardial revascularization) occurred in 246 (22.2%) patients. Central pulsatility was the most powerful predictor of the primary end point (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.14 to 1.48). Central pulse pressure was also independently related to the primary end point (HR 1.25, 95% CI 1.09 to 1.43). Central mean BP as well as peripheral BP parameters were not independently related to the primary end point risk. Central pulsatility was also related to risk of cardiovascular death or myocardial infarction or stroke. The pulsatile component of BP is the most important factor related to the cardiovascular risk in coronary patients. It is more closely associated with cardiovascular risk than steady component of BP.
尽管中心血压与外周血压值之间的差异已为人所知数十年，但基于外周血压而非中心血压进行决策的后果直到最近才被认识到。仅有少数研究评估主动脉内血压与心血管风险之间的关系。此外，一大组冠心病患者的中心血压与心血管事件风险之间的关系尚未得到评估。因此，本研究的目的是确定接受冠状动脉造影患者中基于中心血压得出的指标的预后意义。在基线时测量有创中心血压，并在1109例连续患者超过4.5年的随访期间确定研究终点。246例（22.2%）患者发生了主要终点事件（心血管死亡、心肌梗死、中风、心脏骤停、心脏移植或心肌血运重建）。中心脉搏波强度是主要终点事件的最强预测因子（风险比[HR]1.30，95%置信区间[CI]1.14至1.48）。中心脉压也与主要终点事件独立相关（HR 1.25，95%CI 1.09至1.43）。中心平均血压以及外周血压参数与主要终点事件风险无独立相关性。中心脉搏波强度也与心血管死亡、心肌梗死或中风的风险相关。血压的脉动成分是冠心病患者心血管风险的最重要因素。它比血压的稳定成分与心血管风险的关联更紧密。
