Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.
Department of Obstetrics and Gynaecology, University of Wisconsin, Madison, WI, USA.
Br J Anaesth. 2017 Jul 1;119(1):65-77. doi: 10.1093/bja/aex056.
Preoperative blood pressure (BP) thresholds associated with increased postoperative mortality remain unclear. We investigated the relationship between preoperative BP and 30-day mortality after elective non-cardiac surgery.
We performed a cohort study of primary care data from the UK Clinical Practice Research Datalink (2004-13). Parsimonious and fully adjusted multivariable logistic regression models, including restricted cubic splines for numerical systolic and diastolic BP, for 30-day mortality were constructed. The full model included 29 perioperative risk factors, including age, sex, comorbidities, medications, and surgical risk scale. Sensitivity analyses were conducted for age (>65 vs <65 years old) and the timing of BP measurement.
A total of 251 567 adults were included, with 589 (0.23%) deaths within 30 days of surgery. After adjustment for all risk factors, preoperative low BP was consistently associated with statistically significant increases in the odds ratio (OR) of postoperative mortality. Statistically significant risk thresholds started at a preoperative systolic pressure of 119 mm Hg (adjusted OR 1.02 [95% confidence interval (CI) 1.01-1.02]) compared with the reference (120 mm Hg) and diastolic pressure of 63 mm Hg [OR 1.24 (95% CI 1.03-1.49)] compared with the reference (80 mm Hg). As BP decreased, the OR of mortality risk increased. Subgroup analysis demonstrated that the risk associated with low BP was confined to the elderly. Adjusted analyses identified that diastolic hypertension was associated with increased postoperative mortality in the whole cohort.
In this large observational study we identified a significant dose-dependent association between low preoperative BP values and increased postoperative mortality in the elderly. In the whole population, elevated diastolic, not systolic, BP was associated with increased mortality.
与术后死亡率增加相关的术前血压（BP）阈值仍不清楚。我们研究了择期非心脏手术后术前 BP 与 30 天死亡率之间的关系。
我们对来自英国临床实践研究数据链接（2004-13 年）的初级保健数据进行了队列研究。构建了 30 天死亡率的简约和完全调整的多变量逻辑回归模型，包括数值收缩压和舒张压的限制立方样条。全模型包括 29 个围手术期危险因素，包括年龄、性别、合并症、药物和手术风险评分。对年龄（>65 岁与<65 岁）和 BP 测量时间进行了敏感性分析。
共纳入 251567 名成年人，术后 30 天内死亡 589 人（0.23%）。在调整所有危险因素后，术前低 BP 与术后死亡率的比值比（OR）显著增加相关。统计学上显著的风险阈值始于术前收缩压 119mmHg（调整 OR 1.02[95%置信区间（CI）1.01-1.02]）与参考值（120mmHg）相比，舒张压 63mmHg[OR 1.24（95%CI 1.03-1.49）]与参考值（80mmHg）相比。随着 BP 降低，死亡风险的 OR 增加。亚组分析表明，低 BP 相关的风险仅限于老年人。调整分析发现，整个队列中，舒张性高血压与术后死亡率增加相关。
在这项大型观察性研究中，我们发现术前 BP 值较低与老年人术后死亡率增加之间存在显著的剂量依赖性关系。在整个人群中，升高的舒张压，而不是收缩压，与死亡率增加相关。
