Department of Medicine, Emory University, Atlanta, Georgia, USA.
Heart. 2011 Aug;97(16):1304-11. doi: 10.1136/hrt.2011.225482. Epub 2011 Jun 2.
The exact form of the association between systolic blood pressure (SBP) and heart failure (HF) risk in the elderly remains incompletely defined, especially in individuals not receiving antihypertensive drugs.
To examine the association between SBP and HF risk in the elderly.
Competing-risks proportional hazards modelling of incident HF risk, using 10-year follow-up data from two NIH-sponsored cohort studies: the Cardiovascular Health Study (inception: 1989-90 and 1992-3) and the Health ABC Study (inception: 1997-8).
Community-based cohorts.
4408 participants (age, 72.8 (4.9) years; 53.1% women, 81.7% white; 18.3% black) without prevalent HF and not receiving antihypertensive drugs at baseline.
Incident HF, defined as first adjudicated hospitalisation for HF.
Over 10 years, 493 (11.2%) participants developed HF. Prehypertension (120-139 mm Hg), stage 1 (140-159 mm Hg), and stage 2 (≥160 mm Hg) hypertension were associated with escalating HF risk; HRs versus optimal SBP (<120 mm Hg) in competing-risks models controlling for clinical characteristics were 1.63 (95% CI 1.23 to 2.16; p=0.001), 2.21 (95% CI 1.65 to 2.96; p<0.001) and 2.60 (95% CI 1.85 to 3.64; p<0.001), respectively. Overall 255/493 (51.7%) HF events occurred in participants with SBP <140 mm Hg at baseline. Increasing SBP was associated with higher HF risk in women than in men; no race-SBP interaction was seen. In analyses with continuous SBP, HF risk had a continuous positive association with SBP to levels as low as 113 mm Hg in men and 112 mm Hg in women.
There is a continuous positive association between SBP and HF risk in the elderly for levels of SBP as low as <115 mm Hg; over half of incident HF events occur in individuals with SBP <140 mm Hg.
收缩压（SBP）与老年人心力衰竭（HF）风险之间的确切关联尚不完全明确，尤其是在未服用抗高血压药物的人群中。
探讨 SBP 与老年人 HF 风险之间的关联。
使用两项 NIH 赞助的队列研究（心血管健康研究[1989-1990 年和 1992-1993 年]和健康老龄化研究[1997-1998 年]）的 10 年随访数据，采用竞争风险比例风险模型分析 HF 发病风险。
社区队列。
4408 名参与者（年龄 72.8（4.9）岁；53.1%为女性，81.7%为白人，18.3%为黑人），无HF 病史且基线时未服用抗高血压药物。
新发 HF，定义为首次经裁决的 HF 住院。
10 年内，493 名（11.2%）参与者发生 HF。高血压前期（120-139mmHg）、1 期（140-159mmHg）和 2 期（≥160mmHg）高血压与 HF 风险逐渐升高相关；在竞争风险模型中，与最佳 SBP（<120mmHg）相比，校正临床特征后，HR 分别为 1.63（95%CI 1.23 至 2.16；p=0.001）、2.21（95%CI 1.65 至 2.96；p<0.001）和 2.60（95%CI 1.85 至 3.64；p<0.001）。总体而言，493 例 HF 事件中有 255 例（51.7%）发生在基线 SBP<140mmHg 的参与者中。SBP 升高与 HF 风险增加相关，且在女性中的相关性强于男性；未观察到 SBP 与种族之间存在交互作用。在连续 SBP 分析中，HF 风险与 SBP 呈连续正相关，直至男性 SBP 低至 113mmHg，女性 SBP 低至 112mmHg。
SBP 与老年人 HF 风险之间存在连续正相关，SBP 低至<115mmHg 时即有此关联；超过一半的 HF 事件发生在 SBP<140mmHg 的患者中。
