Jani Bhautesh Dinesh, Cavanagh Jonathan, Barry Sarah J E, Der Geoff, Sattar Naveed, Mair Frances S
General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Mental Health and Wellbeing, Sackler Institute, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
J Clin Hypertens (Greenwich). 2016 Oct;18(10):1027-1035. doi: 10.1111/jch.12813. Epub 2016 Apr 3.
The authors studied the joint effect of blood pressure (BP) and depression on the risk of major adverse cardiovascular outcome in patients with existing cardiometabolic disease. A cohort of 35,537 patients with coronary heart disease, diabetes, or stroke underwent depression screening and BP measurement recorded concurrently. The authors used Cox's proportional hazards to calculate risk of major adverse cardiovascular event (MACE; myocardial infarction/heart failure/stroke or cardiovascular death) over 4 years associated with baseline BP and depression. A total of 11% (3939) had experienced a MACE within 4 years. Patients with very high systolic BP (160-240 mm Hg; hazard ratio, 1.28) and depression (hazard ratio, 1.22) at baseline had significantly higher adjusted risk. Depression had a significant interaction with systolic BP in risk prediction (P=.03). Patients with a combination of high systolic BP and depression at baseline had 83% higher adjusted risk of MACE, as compared with patients with reference systolic BP without depression. Patients with cardiometabolic disease and comorbid depression may benefit from closer monitoring of systolic BP.
作者研究了血压（BP）和抑郁症对现有心脏代谢疾病患者发生主要不良心血管事件风险的联合影响。对35537例冠心病、糖尿病或中风患者进行了抑郁症筛查，并同时记录了血压测量值。作者使用Cox比例风险模型计算了与基线血压和抑郁症相关的4年内主要不良心血管事件（MACE；心肌梗死/心力衰竭/中风或心血管死亡）的风险。共有11%（3939例）在4年内发生了MACE。基线时收缩压非常高（160 - 240 mmHg；风险比，1.28）和患有抑郁症（风险比，1.22）的患者调整后风险显著更高。抑郁症在风险预测中与收缩压有显著交互作用（P = 0.03）。与收缩压处于参考范围且无抑郁症的患者相比，基线时收缩压高且患有抑郁症的患者调整后发生MACE的风险高83%。患有心脏代谢疾病和合并抑郁症的患者可能受益于对收缩压更密切的监测。
