Department of Cardiology, Hospital "S. Maria della Misericordia", Perugia, Italy.
Am J Hypertens. 2011 May;24(5):591-8. doi: 10.1038/ajh.2011.18. Epub 2011 Feb 17.
Elevated neutrophil count, a marker of systemic inflammation, has been suggested as a prognostic marker of cardiovascular disease in postmenopausal women with hypertension. We tested the hypothesis that an association exists between elevated neutrophil count and increased arterial stiffness, as reflected by a wide pulse pressure (PP), in this population of women. We also tested PP as predictor of cardiovascular adverse events in this population.
We analyzed data relating to 886 postmenopausal women with hypertension, consecutively enrolled in a prospective registry. Ambulatory blood pressure monitoring was carried out at entry in all the subjects. The median duration of follow-up was 7.4 years (range: 1-21 years).
There was a direct relationship between neutrophil count and 24-h ambulatory PP (P < 0.0001) and this association remained significant after adjusting for age, serum glucose, and left ventricular (LV) hypertrophy at electrocardiogram (ECG) (all P < 0.01). During follow-up there were 121 first-time major cardiovascular (CV) events. The rate (× 100 patient-years) of CV events was 1.02, 1.36, and 3.75, respectively in the three tertiles of the distribution of 24-h PP (P < 0.0001). In a multivariate analysis, 24-h ambulatory PP and neutrophil count were independent predictors of total CV events after adjusting for the influence of other risk markers. In particular, for each 10 mm Hg increase in 24-h PP, there was a 73% higher risk for total CV events (P = 0.015). Office-recorded PP did not achieve significance when forced in the same model.
Increased arterial stiffness, as reflected in high values of 24-h ambulatory PP, is an adverse prognostic marker in postmenopausal women with hypertension, possibly as an additional correlate of systemic inflammation.
中性粒细胞计数升高是全身炎症的标志物，有研究提示其与高血压绝经后女性的心血管疾病预后相关。本研究旨在检验在这一女性人群中，中性粒细胞计数与动脉僵硬度增加（表现为脉压增宽）之间是否存在关联，并检验脉压是否可预测该人群的心血管不良事件。
我们分析了连续纳入前瞻性登记的 886 例高血压绝经后女性的数据。所有患者在入组时均接受了动态血压监测。中位随访时间为 7.4 年（1~21 年）。
中性粒细胞计数与 24 小时动态脉压呈直接相关（P<0.0001），在校正年龄、血清葡萄糖和心电图左心室肥厚后，这种相关性仍然显著（均 P<0.01）。随访期间共有 121 例首次发生主要心血管不良事件。24 小时动态脉压分布的三分位数中，心血管不良事件的发生率分别为 1.02（×100 患者年）、1.36（×100 患者年）和 3.75（×100 患者年）（P<0.0001）。在多变量分析中，在校正其他风险标志物的影响后，24 小时动态脉压和中性粒细胞计数是总心血管不良事件的独立预测因子。具体而言，24 小时动态脉压每增加 10mmHg，总心血管不良事件的风险增加 73%（P=0.015）。在相同模型中强行纳入诊室记录的脉压时，其未达到统计学意义。
24 小时动态脉压升高反映了动脉僵硬度增加，这是高血压绝经后女性的不良预后标志物，可能是全身炎症的另一个相关因素。
