Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Kapucijnenvoer 35, Block D, Box 7001, BE-3000 Leuven, Belgium.
Hypertension. 2014 Feb;63(2):229-37. doi: 10.1161/HYPERTENSIONAHA.113.02179. Epub 2013 Dec 9.
Evidence-based thresholds for risk stratification based on pulse pressure (PP) are currently unavailable. To derive outcome-driven thresholds for the 24-hour ambulatory PP, we analyzed 9938 participants randomly recruited from 11 populations (47.3% women). After age stratification (<60 versus ≥60 years) and using average risk as reference, we computed multivariable-adjusted hazard ratios (HRs) to assess risk by tenths of the PP distribution or risk associated with stepwise increasing (+1 mm Hg) PP levels. All adjustments included mean arterial pressure. Among 6028 younger participants (68 853 person-years), the risk of cardiovascular (HR, 1.58; P=0.011) or cardiac (HR, 1.52; P=0.056) events increased only in the top PP tenth (mean, 60.6 mm Hg). Using stepwise increasing PP levels, the lower boundary of the 95% confidence interval of the successive thresholds did not cross unity. Among 3910 older participants (39 923 person-years), risk increased (P≤0.028) in the top PP tenth (mean, 76.1 mm Hg). HRs were 1.30 and 1.62 for total and cardiovascular mortality, and 1.52, 1.69, and 1.40 for all cardiovascular, cardiac, and cerebrovascular events. The lower boundary of the 95% confidence interval of the HRs associated with stepwise increasing PP levels crossed unity at 64 mm Hg. While accounting for all covariables, the top tenth of PP contributed less than 0.3% (generalized R(2) statistic) to the overall risk among the elderly. Thus, in randomly recruited people, ambulatory PP does not add to risk stratification below age 60; in the elderly, PP is a weak risk factor with levels below 64 mm Hg probably being innocuous.
目前尚无基于脉压（PP）的风险分层的循证阈值。为了得出 24 小时动态 PP 的结果驱动阈值，我们分析了从 11 个人群中随机招募的 9938 名参与者（47.3%为女性）。在年龄分层（<60 岁与≥60 岁）并以平均风险为参考后，我们计算了多变量调整后的风险比（HR），以评估 PP 分布的十分位数或与逐步增加（+1mmHg）PP 水平相关的风险。所有调整均包括平均动脉压。在 6028 名较年轻的参与者（68853 人年）中，心血管（HR，1.58；P=0.011）或心脏（HR，1.52；P=0.056）事件的风险仅在最高 PP 十分位数（平均 60.6mmHg）中增加。使用逐步增加的 PP 水平，连续阈值的 95%置信区间的下限没有超过 1。在 3910 名较年长的参与者（39923 人年）中，最高 PP 十分位数（平均 76.1mmHg）的风险增加（P≤0.028）。总死亡率和心血管死亡率的 HRs 分别为 1.30 和 1.62，所有心血管、心脏和脑血管事件的 HRs 分别为 1.52、1.69 和 1.40。与逐步增加的 PP 水平相关的 HRs 的 95%置信区间的下限在 64mmHg 时超过 1。在考虑所有协变量的情况下，老年人的总体风险中，最高 PP 十分位数的贡献小于 0.3%（广义 R²统计量）。因此，在随机招募的人群中，动态 PP 在 60 岁以下的风险分层中没有增加作用；在老年人中，PP 是一个较弱的风险因素，低于 64mmHg 的水平可能是无害的。
