Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden.
JAMA. 2010 Mar 24;303(12):1167-72. doi: 10.1001/jama.2010.314.
High resting blood pressure (BP) is among the best studied and established risk factors for cardiovascular disease. However, little is known about the relationship between BP under acute stress, such as in acute chest pain, and subsequent mortality.
To study long-term mortality related to supine BP in patients admitted to the medical intensive care unit (ICU) for acute chest pain.
DESIGN, SETTING, AND PARTICIPANTS: Data from the RIKS-HIA (Registry of Information and Knowledge About Swedish Heart Intensive Care Admissions) was used to analyze the mortality in relation to supine admission systolic BP in 119,151 participants who were treated at the ICU for the symptom of chest pain from 1997 through 2007. Results from this prospective cohort study were presented according to systolic BP quartiles: Q1, less than 128 mm Hg; Q2, from 128 to 144 mm Hg; Q3, from 145 to 162 mm Hg; and Q4, at or above 163 mm Hg.
Total mortality.
Mean (SD) follow-up time was 2.47 (1.5) years (range, 1-10 years). One-year mortality rate by Cox proportional hazard model (adjusted for age, sex, smoking, diastolic BP, use of antihypertensive medication at admission and discharge, and use of lipid-lowering and antiplatelet medication at discharge) showed that participants in Q4 had the best prognosis (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.72-0.80, Q4 compared with Q2; corresponding risks for Q1 were HR, 1.46; 95% CI, 1.39-1.52, and for Q3, HR, 0.83; 95% CI, 0.79-0.87). Patients in Q4 had a 21.7% lower absolute risk compared with Q2, patients in Q3 had a 15.2% lower risk than in Q2, and patients in Q1 had a 40.3% higher risk for mortality than in Q2. The worse prognosis in Q2 compared with Q4 was independent of body mass index and previous diagnoses and similar when analysis was restricted to patients with a final diagnosis of angina or myocardial infarction (HR, 0.75; 95% CI, 0.71-0.80, Q4 compared with Q2).
Among patients admitted to the ICU for chest pain, there is an inverse association between admission supine systolic BP and 1-year mortality rate.
静息血压升高是心血管疾病中研究最多、最确定的危险因素之一。然而，人们对急性压力下（如急性胸痛）的血压与随后的死亡率之间的关系知之甚少。
研究因急性胸痛入住医疗重症监护病房（ICU）的患者仰卧位血压与长期死亡率的关系。
设计、地点和参与者：利用 RIKS-HIA（瑞典心脏重症监护入院信息和知识登记处）的数据，分析了 1997 年至 2007 年间因胸痛症状在 ICU 接受治疗的 119151 名参与者的仰卧位入院收缩压与死亡率的关系。根据收缩压四分位数进行了这项前瞻性队列研究的结果呈现：Q1，小于 128mmHg；Q2，128 至 144mmHg；Q3，145 至 162mmHg；Q4，等于或高于 163mmHg。
总死亡率。
平均（SD）随访时间为 2.47（1.5）年（范围，1-10 年）。Cox 比例风险模型（经年龄、性别、吸烟、舒张压、入院时和出院时使用降压药物以及出院时使用降脂和抗血小板药物校正）的 1 年死亡率显示，Q4 组预后最佳（风险比[HR]，0.76；95%置信区间[CI]，0.72-0.80，Q4 与 Q2 比较；相应的 Q1 风险为 HR，1.46；95%CI，1.39-1.52，Q3 为 HR，0.83；95%CI，0.79-0.87）。与 Q2 相比，Q4 患者的绝对风险降低了 21.7%，Q3 患者的风险降低了 15.2%，Q1 患者的风险增加了 40.3%。与 Q4 相比，Q2 预后较差是独立于体重指数和既往诊断的，当分析仅限于最终诊断为心绞痛或心肌梗死的患者时，结果相似（HR，0.75；95%CI，0.71-0.80，Q4 与 Q2 比较）。
在因胸痛入住 ICU 的患者中，入院时仰卧位收缩压与 1 年死亡率呈负相关。
