Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9047, USA.
Vasc Med. 2011 Aug;16(4):239-46. doi: 10.1177/1358863X11413166. Epub 2011 Jul 5.
Prospective data regarding risk factors for peripheral artery disease (PAD) are sparse, especially among women; the relative contribution of systolic versus diastolic blood pressure control for incident PAD has not been well studied. We evaluated the association of self-reported blood pressure control with incident symptomatic PAD in middle-aged and older women. We examined the relationship between reported hypertension and incident confirmed symptomatic PAD (n = 178) in 39,260 female health professionals aged ≥ 45 years without known vascular disease at baseline. Median follow-up was 13.3 years. Women were grouped according to presence of reported isolated diastolic (IDH), isolated systolic (ISH), or combined systolic-diastolic hypertension (SDH) using cut-points of 90 and 140 mmHg for diastolic and systolic blood pressure, respectively. SBP and DBP were modeled as continuous and categorical exposures. Multivariable-adjusted hazard ratios (HRs), including adjustment for cardiovascular risk factors, were derived from Cox proportional hazards models. Adjusted HRs compared to women without reported hypertension were 1.0 (0.4-2.8) for IDH, 2.0 (1.3-3.1) for ISH, and 2.8 (1.8-4.5) for SDH. There was a 43% increased adjusted risk per 10 mmHg of reported SBP (95% CI 27-62%) and a gradient in risk according to SBP category (< 120, 120-139, 140-159, and ≥ 160 mmHg); HRs were 1.0, 2.3, 4.3, and 6.6 (p-trend < 0.001), respectively. Reported DBP, while individually predictive in models excluding SBP, was not predictive after adjustment for SBP. In conclusion, these prospective data suggest a strong prognostic role for uncontrolled blood pressure and, particularly, uncontrolled systolic blood pressure in the development of peripheral atherosclerosis in women.
前瞻性数据表明，外周动脉疾病（PAD）的风险因素较为少见，尤其是在女性中；收缩压和舒张压控制对 PAD 发病的相对贡献尚未得到很好的研究。我们评估了自我报告的血压控制与中年及以上女性发生症状性 PAD 的关系。我们检查了基线时无已知血管疾病的 39260 名年龄≥45 岁的女性健康专业人员中报告的高血压与确诊的症状性 PAD（n = 178）之间的关系。中位随访时间为 13.3 年。女性根据报告的孤立舒张期高血压（IDH）、孤立收缩期高血压（ISH）或收缩压-舒张压高血压（SDH）的存在进行分组，收缩压和舒张压的切点分别为 90mmHg 和 140mmHg。SBP 和 DBP 作为连续和分类暴露进行建模。多变量调整后的风险比（HR），包括心血管危险因素的调整，来自 Cox 比例风险模型。与无报告高血压的女性相比，IDH 的调整 HR 为 1.0（0.4-2.8），ISH 为 2.0（1.3-3.1），SDH 为 2.8（1.8-4.5）。报告的 SBP 每增加 10mmHg，调整后的风险增加 43%（95%CI 27-62%），并且根据 SBP 类别存在风险梯度（<120、120-139、140-159 和≥160mmHg）；HR 分别为 1.0、2.3、4.3 和 6.6（p 趋势<0.001）。排除 SBP 后，报告的 DBP 在模型中单独具有预测性，但在调整 SBP 后则不具有预测性。总之，这些前瞻性数据表明，血压不受控制，尤其是收缩压不受控制，在外周动脉粥样硬化的发展中具有很强的预后作用。
