Smitson Christopher C, Scherzer Rebecca, Shlipak Michael G, Psaty Bruce M, Newman Anne B, Sarnak Mark J, Odden Michelle C, Peralta Carmen A
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California, USA.
Kidney Health Research Collaborative, Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA.
Am J Hypertens. 2017 Jun 1;30(6):587-593. doi: 10.1093/ajh/hpx028.
Common blood pressure (BP) trajectories are not well established in elderly persons, and their association with clinical outcomes is uncertain.
We used hierarchical cluster analysis to identify discrete BP trajectories among 4,067 participants in the Cardiovascular Health Study using repeated BP measures from years 0 to 7. We then evaluated associations of each BP trajectory cluster with all-cause mortality, incident cardiovascular disease (CVD, defined as stroke or myocardial infarction) (N = 2,837), and incident congestive heart failure (HF) (N = 3,633) using Cox proportional hazard models.
Median age was 77 years at year 7. Over a median 9.3 years of follow-up, there were 2,475 deaths, 659 CVD events, and 1,049 HF events. The cluster analysis identified 3 distinct trajectory groups. Participants in cluster 1 (N = 1,838) had increases in both systolic (SBP) and diastolic (DBP) BPs, whereas persons in cluster 2 (N = 1,109) had little change in SBP but declines in DBP. Persons in cluster 3 (N = 1,120) experienced declines in both SBP and DBP. After multivariable adjustment, clusters 2 and 3 were associated with increased mortality risk relative to cluster 1 (hazard ratio = 1.21, 95% confidence interval: 1.06-1.37 and hazard ratio = 1.20, 95% confidence interval: 1.05-1.36, respectively). Compared to cluster 1, cluster 3 had higher rates of incident CVD but associations were not statistically significant in demographic-adjusted models (hazard ratio = 1.16, 95% confidence interval: 0.96-1.39). Findings were similar when stratified by use of antihypertensive therapy.
Among community-dwelling elders, distinct BP trajectories were identified by integrating both SBP and DBP. These clusters were found to have differential associations with outcomes.
老年人常见的血压轨迹尚未完全明确，其与临床结局的关联也不确定。
我们采用分层聚类分析，利用心血管健康研究中4067名参与者在第0年至第7年的重复血压测量数据，来确定不同的血压轨迹。然后，我们使用Cox比例风险模型评估每个血压轨迹组与全因死亡率、心血管疾病（CVD，定义为中风或心肌梗死）（N = 2837）以及充血性心力衰竭（HF）（N = 3633）的关联。
在第7年时，中位年龄为77岁。在中位9.3年的随访期内，有2475例死亡、659例心血管疾病事件和1049例心力衰竭事件。聚类分析确定了3个不同的轨迹组。第1组（N = 1838）的参与者收缩压（SBP）和舒张压（DBP）均升高，而第2组（N = 1109）的参与者SBP变化不大，但DBP下降。第3组（N = 1120）的参与者SBP和DBP均下降。经过多变量调整后，与第1组相比，第2组和第3组的死亡风险增加（风险比分别为1.21，95%置信区间：1.06 - 1.37和风险比为1.20，95%置信区间：1.05 - 1.36）。与第1组相比，第3组的心血管疾病发生率较高，但在人口统计学调整模型中关联无统计学意义（风险比 = 1.16，95%置信区间：0.96 - 1.39）。按抗高血压治疗的使用情况分层时，结果相似。
在社区居住的老年人中，通过整合SBP和DBP确定了不同的血压轨迹。这些组与结局存在不同的关联。
