在老年养老院人群中，死亡率和心血管事件最好通过低中心/外周脉搏压放大来预测，而不是通过高血压水平来预测：PARTAGE（机构化非常高龄人群血压和动脉僵硬度预测值）研究。
Mortality and cardiovascular events are best predicted by low central/peripheral pulse pressure amplification but not by high blood pressure levels in elderly nursing home subjects: the PARTAGE (Predictive Values of Blood Pressure and Arterial Stiffness in Institutionalized Very Aged Population) study.
机构信息
Inserm U961, Nancy, France.
出版信息
J Am Coll Cardiol. 2012 Oct 16;60(16):1503-11. doi: 10.1016/j.jacc.2012.04.055. Epub 2012 Sep 19.
OBJECTIVES
The aim of the longitudinal PARTAGE study was to determine the predictive value of blood pressure (BP) and pulse pressure amplification, a marker of arterial function, for overall mortality (primary endpoint) and major cardiovascular (CV) events, in subjects older than 80 years of age living in a nursing home.
BACKGROUND
Assessment of pulse indexes may be important in the evaluation of the CV risk in very elderly frail subjects.
METHODS
A total of 1,126 subjects (874 women) who were living in French and Italian nursing homes were enrolled (mean age, 88 ± 5 years). Central (carotid) to peripheral (brachial) pulse pressure amplification (PPA) was calculated with the help of an arterial tonometer. Clinical and 3-day self-measurements of BP were conducted.
RESULTS
During the 2-year follow-up, 247 subjects died, and 228 experienced major CV events. The PPA was a predictor of total mortality and major CV events in this population. A 10% increase in PPA was associated with a 24% (p < 0.0003) decrease in total mortality and a 17% (p < 0.01) decrease in major CV events. Systolic BP, diastolic BP, or pulse pressure were either not associated or inversely correlated with total mortality and major CV events.
CONCLUSIONS
In very elderly individuals living in nursing homes, low PPA from central to peripheral arteries strongly predicts mortality and adverse effects. Assessment of this parameter could help in risk estimation and improve diagnostic and therapeutic strategies in very old, polymedicated persons. In contrast, high BP is not associated with higher risk of mortality or major CV events in this population. (Predictive Values of Blood Pressure and Arterial Stiffness in Institutionalized Very Aged Population [PARTAGE]; NCT00901355).
目的
PARTAGE 纵向研究的目的是确定血压（BP）和脉搏压放大（动脉功能的一个标志物）对整体死亡率（主要终点）和主要心血管（CV）事件的预测价值，研究对象为居住在养老院的 80 岁以上老年人。
背景
评估脉搏指数对于评估非常高龄体弱患者的 CV 风险可能很重要。
方法
共纳入 1126 名（874 名女性）居住在法国和意大利养老院的受试者（平均年龄 88 ± 5 岁）。利用动脉血压计计算中心（颈动脉）到外周（肱动脉）脉搏压放大率（PPA）。进行临床和 3 天的自我血压测量。
结果
在 2 年的随访期间，247 名受试者死亡，228 名受试者发生主要 CV 事件。在该人群中，PPA 是总死亡率和主要 CV 事件的预测指标。PPA 增加 10%，总死亡率降低 24%（p < 0.0003），主要 CV 事件降低 17%（p < 0.01）。收缩压、舒张压或脉压与总死亡率和主要 CV 事件无相关性或呈负相关。
结论
在居住在养老院的非常高龄个体中，中心动脉到外周动脉的低 PPA 强烈预示死亡率和不良影响。评估该参数有助于风险估计，并改善非常高龄、多药物治疗患者的诊断和治疗策略。与此相反，在该人群中，高 BP 与死亡率或主要 CV 事件的风险增加无关。（居住在机构化非常高龄人群中的血压和动脉僵硬度的预测值[PARTAGE]；NCT00901355）。
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