Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece.
1st Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Greece.
Am J Hypertens. 2017 Nov 1;30(11):1093-1099. doi: 10.1093/ajh/hpx110.
Blood pressure (BP) includes a steady (mean arterial pressure, MAP) and a pulsatile component that independently predict mortality. The association between longitudinal changes in central (c) pulse pressure (PP), brachial (b) PP, MAP, and incident mortality has never been investigated in this context.
Brachial MAP and PP were measured at 2 routine checkups (1st visit 1992; mean interval, 5.8 ± 2.4 years) in 71,629 individuals, age 16-95 years, none on antihypertensive drugs. cPP was estimated with a validated algorithm. Each change (visit 2-1) in bPP, cPP, and MAP, expressed in mm Hg/year, was categorized as: increase, decrease, or no-change, with the latter representing the control-group. Follow-up data (6.9 ± 3.3 years) on all-cause mortality (2,033 deaths) were documented.
All-cause mortality Cox regression models adjusted for confounders showed that compared to the subgroup with steady BP at both visits, the subgroup with: (i) increased bPP or cPP had an approximately 200% increase in relative risk (RR); (ii) decreased cPP and bPP had a 15% reduction in RR; (iii) increased MAP had a 68% increase in RR; (iv) decreased MAP had a 7% increase in RR of mortality. Interaction analysis stratified by gender showed that annual increases in PP, but not MAP, were greater in younger than older men and lower in younger than older women. Age cutoff value was 55 years.
MAP and PP have distinct characteristics affecting all-cause mortality. PP integrates the effects of age and gender on all-cause mortality more notably than MAP, thus impacting significantly on cardiovascular risk.
血压（BP）包括稳定（平均动脉压，MAP）和脉动成分，这两者均可独立预测死亡率。在这种情况下，中心（c）脉压（PP）、肱动脉（b）PP、MAP 的纵向变化与发病死亡率之间的关系从未被研究过。
在 71629 名年龄在 16-95 岁之间、无抗高血压药物的个体中，在 2 次常规检查（第一次就诊为 1992 年；平均间隔时间为 5.8±2.4 年）时测量肱动脉 MAP 和 PP，使用经过验证的算法估计 cPP。以 mm Hg/年为单位表示的 bPP、cPP 和 MAP 的每个变化（访视 2-1），分为增加、减少或不变，后者代表对照组。记录了所有原因死亡率（2033 例死亡）的随访数据（6.9±3.3 年）。
经混杂因素调整的全因死亡率 Cox 回归模型显示，与两次就诊时血压稳定的亚组相比，以下亚组的相对风险（RR）增加约 200%：（i）bPP 或 cPP 增加；（ii）cPP 和 bPP 减少；RR 降低 15%；（iii）MAP 增加，RR 增加 68%；（iv）MAP 降低，RR 增加 7%。按性别分层的交互分析表明，PP 而不是 MAP 的年增长率在年轻男性中大于老年男性，在年轻女性中小于老年女性。年龄截断值为 55 岁。
MAP 和 PP 具有不同的特征，影响全因死亡率。PP 比 MAP 更能综合年龄和性别对全因死亡率的影响，从而对心血管风险产生重大影响。
