Pini Riccardo, Cavallini M Chiara, Palmieri Vittorio, Marchionni Niccolò, Di Bari Mauro, Devereux Richard B, Masotti Giulio, Roman Mary J
Department of Critical Care Medicine and Surgery-Unit of Geriatric Cardiology, University of Firenze and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
J Am Coll Cardiol. 2008 Jun 24;51(25):2432-9. doi: 10.1016/j.jacc.2008.03.031.
The present study investigated whether central blood pressure (BP) predicts cardiovascular (CV) events better than brachial BP in a cohort of normotensive and untreated hypertensive elderly individuals.
Limited and conflicting data have been reported on the prognostic relevance of central BP compared with brachial BP.
Community-dwelling individuals > or =65 years of age, living in Dicomano, Italy, underwent an extensive clinical assessment in 1995 including echocardiography and carotid ultrasonography and applanation tonometry. In 2003, vital status and CV events were assessed, reviewing the electronic database of the Regional Ministry of Health. Only normotensive (n = 173) and untreated hypertensive subjects (95 diastolic and 130 isolated systolic) were included in the present analysis.
During 8 years, 106 deaths, 45 of which were cardiovascular, and 122 CV events occurred. In univariate analyses, both central and brachial systolic blood pressure (SBP) and pulse pressure (PP) predicted CV events (all p < 0.005); however, in multivariate analyses, adjusting for age and gender, higher carotid SBP and PP (hazard ratios 1.19/10 and 1.23/10 mm Hg, respectively; both p < 0.0001) but neither brachial SBP nor PP independently predicted CV events. Similarly, higher carotid SBP but not brachial pressures independently predicted CV mortality (hazard ratio 1.37/10 mm Hg; p < 0.0001).
Our prospective study in an unselected geriatric population demonstrates superior prognostic utility of central compared with brachial BP.
本研究调查了在一组血压正常和未经治疗的老年高血压个体中，中心血压（BP）是否比肱动脉血压能更好地预测心血管（CV）事件。
关于中心血压与肱动脉血压的预后相关性，已报道的数据有限且相互矛盾。
1995年，居住在意大利迪科马诺、年龄≥65岁的社区居民接受了包括超声心动图、颈动脉超声检查和压平眼压测量在内的广泛临床评估。2003年，通过查阅地区卫生部的电子数据库评估生命状态和心血管事件。本分析仅纳入血压正常者（n = 173）和未经治疗的高血压患者（95例舒张期高血压和130例单纯收缩期高血压）。
在8年期间，发生了106例死亡，其中45例为心血管死亡，以及122例心血管事件。在单因素分析中，中心和肱动脉收缩压（SBP）及脉压（PP）均能预测心血管事件（所有p < 0.005）；然而，在多因素分析中，校正年龄和性别后，较高的颈动脉SBP和PP（风险比分别为1.19/10和1.23/10 mmHg；均p < 0.0001）可独立预测心血管事件，而肱动脉SBP和PP均不能。同样，较高的颈动脉SBP而非肱动脉血压可独立预测心血管死亡率（风险比1.37/10 mmHg；p < 0.0001）。
我们在未选择的老年人群中的前瞻性研究表明，与肱动脉血压相比，中心血压具有更好的预后预测价值。
