British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
Hypertension. 2012 Sep;60(3):631-8. doi: 10.1161/HYPERTENSIONAHA.112.191510. Epub 2012 Jul 16.
Hematocrit has been inconsistently reported to be a risk marker of cardiovascular morbidity and mortality. The Glasgow Blood Pressure Clinic Study cohort included 10951 hypertensive patients, who had hematocrit measured at their initial clinic visit and followed for ≤35 years. Cox proportional hazards models were used to estimate hazard ratios for all-cause, cardiovascular, ischemic heart disease, stroke, and noncardiovascular mortality. There were 3484 deaths over a follow-up period of 173245 person-years. Hematocrit was higher in men (median, 0.44; interquartile range, 0.42-0.47) than in women (median, 0.41; interquartile range, 0.38-0.43). The lowest risk for all-cause mortality was seen in quartile 2 for men (range, 0.421-0.440) and women (range, 0.381-0.400). Compared with quartile 2, the adjusted hazard ratios for quartiles 1, 3, and 4 were, respectively, 1.11 (range, 0.97-1.28), 1.19 (range, 1.04-1.37), and 1.22 (range, 1.06-1.39) in men and 1.17 (range, 1.01-1.36), 0.97 (range, 0.83-1.13), and 1.19 (range, 1.04-1.37) in women. Men showed a J-shaped pattern for cardiovascular mortality and a linear pattern for noncardiovascular mortality in cause-specific analysis, whereas in women a U-shaped pattern was observed for noncardiovascular mortality only. Higher baseline hematocrit was associated with higher on-treatment blood pressure during follow-up. Baseline hematocrit did not affect the time to reach target blood pressure. The increased risk of death attributed to higher hematocrit was seen in men and women irrespective of their achievement of target blood pressure, indicating that the risk is independent of the effect of hematocrit on blood pressure. Hypertensive patients with hematocrit levels outside of the sex-specific reference ranges identified in this study should be targeted for more aggressive blood pressure and cardiovascular risk reduction treatment.
血细胞比容一直被认为是心血管发病率和死亡率的一个风险标志物，但报道结果并不一致。在格拉斯哥血压诊所研究队列中纳入了 10951 例高血压患者，他们在首次就诊时进行了血细胞比容检测，并随访了 ≤35 年。采用 Cox 比例风险模型估计全因死亡率、心血管死亡率、缺血性心脏病死亡率、卒中和非心血管死亡率的风险比。在 173245 人年的随访期间，发生了 3484 例死亡。男性的血细胞比容高于女性（中位数，0.44；四分位距，0.42-0.47）（中位数，0.41；四分位距，0.38-0.43）。男性全因死亡率最低风险见于第 2 四分位组（范围，0.421-0.440），女性见于第 2 四分位组（范围，0.381-0.400）。与第 2 四分位组相比，第 1、3 和 4 四分位组的校正风险比分别为 1.11（范围，0.97-1.28）、1.19（范围，1.04-1.37）和 1.22（范围，1.06-1.39）（范围，1.17；范围，1.01-1.36），0.97（范围，0.83-1.13）和 1.19（范围，1.04-1.37）。在男性中，心血管死亡率呈 J 形模式，而非心血管死亡率呈线性模式，而在女性中，仅观察到非心血管死亡率呈 U 形模式。在随访期间，较高的基线血细胞比容与较高的治疗后血压相关。基线血细胞比容并不影响达到目标血压的时间。较高的血细胞比容导致的死亡风险增加见于男性和女性，无论其是否达到目标血压，表明这种风险独立于血细胞比容对血压的影响。在这项研究中，无论性别如何，血细胞比容水平超出特定参考范围的高血压患者应针对更积极的降压和心血管风险降低治疗。
