Taylor J O, Cornoni-Huntley J, Curb J D, Manton K G, Ostfeld A M, Scherr P, Wallace R B
Channing Laboratory, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA.
Am J Epidemiol. 1991 Sep 1;134(5):489-501. doi: 10.1093/oxfordjournals.aje.a116121.
Blood pressure was assessed between 1981 and 1983 in all persons over age 65 years in three communities (East Boston, Massachusetts; New Haven, Connecticut; and Iowa and Washington countries, Iowa), and cause-specific mortality was monitored annually over the subsequent 5 years as part of the National Institute on Aging-sponsored Established Populations for Epidemiologic Studies of the Elderly. Each community had 80% or more participation: in East Boston, 3,809 persons with 903 deaths, in New Haven, 2,812 persons with 804 deaths, and in Iowa, 3,673 persons with 763 deaths. At 2 years, odds of death from all causes were higher in the low (less than 130 mmHg) than the middle (130-159 mmHg) systolic blood pressure group for persons aged 65-79 years in all three populations. By 5 years, cardiovascular death increased with increasing systolic pressure in all three communities and reached significance in Iowa. Cancer death was highest in the low systolic pressure stratum in all three centers. All-cause, cardiovascular death, and cancer mortality was highest in the low (less than 75 mmHg) diastolic blood pressure group in East Boston, even at 5 years. Blood pressures obtained 9 years earlier in 2,079 (68%) of the East Boston participants showed a significantly higher risk of cardiovascular death with increasing systolic pressure and no relation between diastolic pressure and mortality risk. In the elderly, excess mortality at lower levels of blood pressure during early follow-up may in part be due to the effects of illness and disability present at baseline. This may obscure the usual rise in mortality with increasing systolic pressure. There is no consistent relation between diastolic pressure and mortality.
1981年至1983年期间，对三个社区（马萨诸塞州东波士顿；康涅狄格州纽黑文；爱荷华州的爱荷华县和华盛顿县）所有65岁以上的人进行了血压评估，并在随后的5年中每年监测特定病因死亡率，这是美国国立衰老研究所资助的老年人流行病学研究既定人群项目的一部分。每个社区的参与率都达到了80%或更高：在东波士顿，有3809人，其中903人死亡；在纽黑文，有2812人，其中804人死亡；在爱荷华州，有3673人，其中763人死亡。在2年时，在所有三个人口中，65至79岁的人群中，收缩压低（低于130 mmHg）组的全因死亡几率高于收缩压中等（130 - 159 mmHg）组。到5年时，在所有三个社区中，心血管死亡随着收缩压的升高而增加，在爱荷华州达到显著水平。在所有三个中心，收缩压低的人群中癌症死亡率最高。在东波士顿，舒张压低（低于75 mmHg）组的全因、心血管死亡和癌症死亡率最高，即使在5年时也是如此。在东波士顿2079名（68%）参与者中，9年前测得的血压显示，随着收缩压升高，心血管死亡风险显著增加，而舒张压与死亡风险之间无关联。在老年人中，早期随访期间血压较低时的额外死亡率可能部分归因于基线时存在的疾病和残疾的影响。这可能掩盖了随着收缩压升高通常出现的死亡率上升。舒张压与死亡率之间没有一致的关系。
