Li Shijun, Barywani Salim, Fu Michael
aSection of Cardiology, Department of Medicine, Sahlgrenska University Hospital, Östra Hospital, Gothenburg, Sweden bSection of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China.
J Hypertens. 2015 Feb;33(2):279-86. doi: 10.1097/HJH.0000000000000403.
The impact of lower pulse pressure (PP) on long-term all-cause mortality in the octogenarian patients with acute coronary syndrome (ACS) remains unknown. This study sought to reveal the prognostic power of lower PP in long-term all-cause mortality in the octogenarian ACS patients.
The current study included a total of 353 consecutive ACS patients aged at least 80 years during the period of 5-year follow-up. Association between PP and long-term mortality was confirmed by sensitivity analyses such as propensity score matching and multivariate Cox analyses. The matched cohort was developed by one-to-one, nearest-neighbor propensity score matching analyses.
Among patients with ACS, 113 (32.1%) admissions were alive, 240 (67.9%) were dead. There was a U-shaped association of mortality rate with PP, and the mortality rate increased in patients with PP equal to or less than 50 mmHg and greater than 70 mmHg. PP equal to or less than 50 mmHg was a predictor of the mortality rate in the overall cohort [hazard ratio: 1.92, 95% confidence interval (CI): 1.08-3.43, P = 0.027] and in the matched cohort (hazard ratio: 2.67, 95% CI: 1.16-6.14, P = 0.020). Moreover, PP equal to or less than 50 mmHg was independently related to mortality rate in the subgroup with hypertension in the overall cohort (hazard ratio: 2.04, 95% CI: 1.04-4.00, P = 0.039) and in the matched cohort (hazard ratio: 2.63, 95% CI: 1.01-6.83, P = 0.048).
This study reveals a U-shaped association of mortality rate with PP in the octogenarians with ACS and demonstrates that PP equal to or less than 50 mmHg has an independent prognostic power in long-term all-cause mortality in the octogenarians with ACS as well as the subgroup with hypertension.
较低脉压（PP）对老年急性冠脉综合征（ACS）患者长期全因死亡率的影响尚不清楚。本研究旨在揭示较低PP对老年ACS患者长期全因死亡率的预后价值。
本研究纳入了353例年龄至少80岁的连续ACS患者，进行为期5年的随访。通过倾向得分匹配和多变量Cox分析等敏感性分析确定PP与长期死亡率之间的关联。匹配队列通过一对一、最近邻倾向得分匹配分析构建。
在ACS患者中，113例（32.1%）存活，240例（67.9%）死亡。死亡率与PP呈U形关联，PP等于或小于50 mmHg以及大于70 mmHg时死亡率升高。PP等于或小于50 mmHg是总体队列（风险比：1.92，95%置信区间[CI]：1.08 - 3.43，P = 0.027）和匹配队列（风险比：2.67，95% CI：1.16 - 6.14，P = 0.020）死亡率的预测指标。此外，在总体队列（风险比：2.04，95% CI：1.04 - 4.00，P = 0.039）和匹配队列（风险比：2.63，95% CI：1.01 - 6.83，P = 0.048）中，PP等于或小于50 mmHg与高血压亚组的死亡率独立相关。
本研究揭示了老年ACS患者死亡率与PP呈U形关联，并表明PP等于或小于50 mmHg对老年ACS患者以及高血压亚组的长期全因死亡率具有独立的预后价值。
