Miura Katsuyuki, Nakagawa Hideaki, Ohashi Yasuo, Harada Akiko, Taguri Masataka, Kushiro Toshio, Takahashi Atsuhiko, Nishinaga Masanori, Soejima Hirofumi, Ueshima Hirotsugu
Department of Health Science, Shiga University of Medical Science, Otsu, Shiga, Japan.
Circulation. 2009 Apr 14;119(14):1892-8. doi: 10.1161/CIRCULATIONAHA.108.823112. Epub 2009 Mar 30.
Information has been sparse on the comparison of 4 blood pressure (BP) indexes (systolic BP [SBP], diastolic BP, pulse pressure, and mean BP [MBP]) in relation to long-term incidence of stroke and myocardial infarction, particularly in middle-aged and older Asians.
The Japan Arteriosclerosis Longitudinal Study Group conducted a meta-analysis of 16 cohort studies in Japan. A total of 48,224 men and women 40 to 89 years of age participated at baseline, and 1231 stroke events and 220 myocardial infarction events occurred during an average 8.4-year follow-up. Multivariate-adjusted hazard ratios with a 1-SD higher value for each BP index were determined by Poisson regression. Analyses were also done in 4 age-sex groups. All 4 BP indexes were significantly related to all stroke risk. Stroke risk was most strongly related to MBP and SBP in both sexes and most weakly related to pulse pressure. Both stroke subtypes, ischemic and hemorrhagic, were most strongly related to MBP and SBP in both sexes. In addition, in men and women 70 to 89 years of age, MBP or SBP showed the strongest relation to all stroke risk. Myocardial infarction risk was most strongly related to SBP or MBP in both sexes. For any end points in any age-sex groups, pulse pressure was not the strongest predictor.
The long-term incident risk of stroke and myocardial infarction associated with high BP in East Asian populations should be assessed mainly on the basis of SBP. MBP also may be an important predictor, but pulse pressure is a less important predictor for cardiovascular disease risk.
关于4种血压（BP）指标（收缩压[SBP]、舒张压、脉压和平均血压[MBP]）与中风和心肌梗死长期发病率的比较，相关信息一直较少，尤其是在中老年亚洲人群中。
日本动脉硬化纵向研究小组对日本的16项队列研究进行了荟萃分析。共有48224名年龄在40至89岁之间的男性和女性参与了基线研究，在平均8.4年的随访期间发生了1231例中风事件和220例心肌梗死事件。通过泊松回归确定每个血压指标每升高1个标准差的多变量调整风险比。还对4个年龄性别组进行了分析。所有4种血压指标均与所有中风风险显著相关。中风风险在两性中与平均血压和收缩压的相关性最强，与脉压的相关性最弱。缺血性和出血性这两种中风亚型在两性中与平均血压和收缩压的相关性也最强。此外，在70至89岁的男性和女性中，平均血压或收缩压与所有中风风险的关系最为密切。心肌梗死风险在两性中与收缩压或平均血压的相关性最强。对于任何年龄性别组的任何终点，脉压都不是最强的预测指标。
东亚人群中与高血压相关的中风和心肌梗死的长期发病风险应主要基于收缩压进行评估。平均血压也可能是一个重要的预测指标，但脉压对心血管疾病风险的预测作用较小。
