其他心血管危险因素是否会影响年龄对血压与死亡率之间关联的影响？MORGAM项目。

Do other cardiovascular risk factors influence the impact of age on the association between blood pressure and mortality? The MORGAM Project.

作者信息

Vishram Julie K K, Borglykke Anders, Andreasen Anne H, Jeppesen Jørgen, Ibsen Hans, Jørgensen Torben, Broda Grazyna, Palmieri Luigi, Giampaoli Simona, Donfrancesco Chiara, Kee Frank, Mancia Giuseppe, Cesana Giancarlo, Kuulasmaa Kari, Salomaa Veikko, Sans Susana, Ferrieres Jean, Tamosiunas Abdonas, Söderberg Stefan, McElduff Patrick, Arveiler Dominique, Pajak Andrzej, Olsen Michael H

机构信息

aCardiovascular Department of Internal Medicine, Cardiovascular Research Unit bResearch Centre for Prevention and Health, Glostrup University Hospital, Glostrup cDivision of Cardiology, Holbaek University Hospital, Holbaek, Denmark dDepartment of Cardiovascular Epidemiology and Prevention, the Cardinal Stefan Wyszynski, Institute of Cardiology, Warsaw, Poland eCerebro and Cardiovascular Epidemiology Unit, National Centre of Epidemiology, Surveillance, and Promotion of Health, National Institute of Health, Rome, Italy fUKCRC Centre of Excellence for Public Health Research (NI), the Queen's University of Belfast, Belfast, Northern Ireland, UK gClinica Medica e Istituto Auxologico Italiano, Milan hResearch Centre on Chronic Degenerative Diseases (Osp. S. Gerardo), Monza, Italy iNational Institute for Health and Welfare (THL), Helsinki, Finland jDepartment of Health, Institute of Health Studies, Barcelona, Spain kDepartment of Cardiology, Rangueil Hospital, Toulouse University School of Medicine, Toulouse, France lInstitute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania mDepartment of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umeå University, Umeå, Sweden nSchool of Medicine and Public Health, University of Newcastle, New Castle, New South Wales, Australia oFaculty of Medicine, Department of Epidemiology and Public Health, University of Strasbourg, Strasbourg, France pDepartment of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University of Medical College, Krakow, Poland qDepartment of Endocrinology, The Cardiovascular and Metabolic Preventive Clinic, Center for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark rHypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.

出版信息

J Hypertens. 2014 May;32(5):1025-32; discussion 1033. doi: 10.1097/HJH.0000000000000133.

DOI:10.1097/HJH.0000000000000133

PMID:24569413

Abstract

OBJECTIVE

To investigate age-related shifts in the relative importance of SBP and DBP as predictors of cardiovascular mortality and all-cause mortality and whether these relations are influenced by other cardiovascular risk factors.

METHODS

Using 42 cohorts from the MORGAM Project with baseline between 1982 and 1997, 85 772 apparently healthy Europeans and Australians aged 19-78 years were included. During 13.3 years of follow-up, 9.2% died (of whom 7.2% died due to stroke and 21.1% due to coronary heart disease, CHD).

RESULTS

Mortality risk was analyzed using hazard ratios per 10-mmHg/5-mmHg increase in SBP/DBP by multivariate-adjusted Cox regressions, including SBP and DBP simultaneously. Because of nonlinearity, SBP and DBP were analyzed separately for blood pressure (BP) values above and below a cut-point wherein mortality risk was the lowest. For the total population, significantly positive associations were found between stroke mortality and SBP [hazard ratio = 1.19 (1.13-1.25)] and DBP at least 78 mmHg [hazard ratio = 1.08 (1.02-1.14)], CHD mortality and SBP at least 116 mmHg [1.20 (1.16-1.24)], and all-cause mortality and SBP at least 120 mmHg [1.09 (1.08-1.11)] and DBP at least 82 mmHg [1.03 (1.02-1.05)]. BP values below the cut-points were inversely related to mortality risk. Taking into account the age × BP interaction, there was a gradual shift from DBP (19-26 years) to both DBP and SBP (27-62 years) and to SBP (63-78 years) as risk factors for stroke mortality and all-cause mortality, but not CHD mortality. The age at which the importance of SBP exceeded DBP was for stroke mortality influenced by sex, cholesterol, and country risk.

CONCLUSION

Age-related shifts to the superiority of SBP exist for stroke mortality and all-cause mortality, and for stroke mortality was this shift influenced by other cardiovascular risk factors.

摘要

目的

研究收缩压（SBP）和舒张压（DBP）作为心血管疾病死亡率和全因死亡率预测指标的相对重要性随年龄的变化，以及这些关系是否受其他心血管危险因素的影响。

方法

使用MORGAM项目中的42个队列，基线时间为1982年至1997年，纳入了85772名年龄在19 - 78岁之间、表面健康的欧洲人和澳大利亚人。在13.3年的随访期间，9.2%的人死亡（其中7.2%死于中风，21.1%死于冠心病）

结果

采用多变量调整的Cox回归分析每10 mmHg/5 mmHg的SBP/DBP升高时的风险比来分析死亡风险，同时纳入SBP和DBP。由于存在非线性关系，将SBP和DBP分别针对死亡率风险最低的切点上下血压（BP）值进行分析。对于总体人群，发现中风死亡率与SBP [风险比 = 1.19（1.13 - 1.25）]以及至少78 mmHg的DBP [风险比 = 1.08（1.02 - 1.14）]、冠心病死亡率与至少116 mmHg 的SBP [1.20（1.16 - 1.24）]、全因死亡率与至少120 mmHg的SBP [1.09（1.08 - 1.11）]以及至少82 mmHg的DBP [1.03（1.02 -1.05）]之间存在显著正相关；切点以下的BP值与死亡风险呈负相关考虑年龄×血压的相互作用，作为中风死亡率和全因死亡率风险因素，存在从DBP（19 - 26岁）到DBP加SBP（27 - 62岁）再到SBP（63 - 78岁）的逐渐转变，但冠心病死亡率不存在这种转变。SBP重要性超过DBP的年龄因中风死亡率受性别、胆固醇和国家风险的影响。