Salazar Martin R, Espeche Walter G, Aizpurúa Marcelo, Leiva Sisnieguez Betty C, Balbín Eduardo, Dulbecco Carlos A, Carbajal Horacio A
Hospital Universitario San Martín, La Plata, Buenos Aires, Argentina;
Hospital Municipal, Rauch city, Buenos Aires, Argentina.
Am J Hypertens. 2014 Aug;27(8):1061-8. doi: 10.1093/ajh/hpt240. Epub 2014 Jan 3.
The significance in terms of the cardiovascular outcome of different patterns of blood pressure (BP) response to community-based activities has not been previously studied. The aim of our study was to evaluate the relationship between changes of BP observed during a community-based program and long-term rate of cardiovascular disease (CVD) events.
A program focused on the prevention of CVDs was implemented in a small city in Argentina over a 6-year period (1997-2003). The program was evaluated using a cohort of 1,526 randomly selected individuals. The population's mean systolic BP (SBP) decreased approximately 5mm Hg, but BP changes were heterogeneous. Eight years after the intervention had stopped, 1,124 individuals of the cohort were surveyed to evaluate incident CVD events. The sample was divided into 3 SBP change categories during the intervention: decrease (< -5mm Hg), no change (-5 to 5mm Hg) and increase (> 5mm Hg). Cox models were used to estimate the hazard ratio (HR) of CVD events for each category adjusted for age, sex, and baseline BP.
At the end of the intervention, individuals who had increased their SBP showed an adjusted HR for CVD that was double those whose SBP levels decreased or did not change. An inverse relationship between baseline SBP and ΔSBP was observed: individuals with an increase in BP during the intervention had lower SBP at the beginning of the study.
BP increase during the community-based program was an independent predictor of CVD events.
此前尚未研究不同血压（BP）对社区活动反应模式在心血管结局方面的意义。我们研究的目的是评估在一项社区项目中观察到的血压变化与心血管疾病（CVD）事件的长期发生率之间的关系。
在阿根廷的一个小城市实施了一项为期6年（1997 - 2003年）的以预防CVD为重点的项目。该项目使用一组1526名随机选择的个体进行评估。人群的平均收缩压（SBP）下降了约5mmHg，但血压变化是异质性的。干预停止8年后，对该队列中的1124名个体进行调查以评估CVD事件的发生情况。在干预期间，将样本分为3个SBP变化类别：下降（< -5mmHg）、无变化（-5至5mmHg）和上升（> 5mmHg）。使用Cox模型估计每个类别经年龄、性别和基线血压调整后的CVD事件风险比（HR）。
在干预结束时，SBP升高的个体经调整后的CVD风险比是SBP水平下降或未变化个体的两倍。观察到基线SBP与ΔSBP之间呈负相关：在干预期间血压升高的个体在研究开始时SBP较低。
在基于社区的项目中血压升高是CVD事件的独立预测因素。
