Saladini Francesca, Fania Claudio, Mos Lucio, Mazzer Adriano, Casiglia Edoardo, Palatini Paolo
From the Department of Medicine, University of Padova, Padua, Italy (F.S., C.F., E.C., P.P.); Emergency Department, Town Hospital, San Daniele del Friuli, Italy (L.M.); and Department of Medicine, Town Hospital, Vittorio Veneto, Italy (Adriano Mazzer).
Hypertension. 2017 Jul 24. doi: 10.1161/HYPERTENSIONAHA.117.09516.
The role of pulse pressure in young individuals remains controversial. The aim of the present study was to investigate the clinical significance of elevated pulse pressure in young- to middle-aged subjects screened for stage 1 hypertension. We examined 1241 subjects (mean age, 33.1±8.4 years) from the HARVEST (Hypertension Ambulatory Recording Venetia Study), during a median follow-up of 12.1 years. To evaluate the predictive value of pulse pressure and mean blood pressure for future hypertension needing treatment and for cardiovascular events, participants were grouped into pressure tertiles. Significant determinants of pulse pressure were male sex (=0.029), younger age (<0.001), physical activity (=0.003), heart rate (<0.001), systolic white coat effect (<0.001), and stroke volume (n=829; <0.001). During follow-up, 65.1% of participants developed hypertension requiring pharmacological treatment and 5.1% experienced a cardiovascular event. Participants in the highest pulse pressure tertile had a reduced risk of incident hypertension compared with those of the bottom tertile (hazard ratio, 0.75; 95% confidence interval, 0.62-0.91; =0.003). In contrast, participants in the top mean blood pressure tertile had an increase in risk (1.91; 1.57-2.33; <0.001). In addition, participants in the highest pulse pressure tertile had a reduced risk of cardiovascular events (0.35; 0.17-0.73; =0.005) and those in the top mean blood pressure tertile had an increase in risk (3.06; 1.32-7.09; =0.009). Our data show that in subjects <45 years, only mean blood pressure is a predictor of adverse outcome whereas high pulse pressure even carries a reduced risk.
脉压在年轻人中的作用仍存在争议。本研究的目的是调查在筛查出1级高血压的中青年受试者中脉压升高的临床意义。我们对来自HARVEST（威尼斯高血压动态记录研究）的1241名受试者（平均年龄33.1±8.4岁）进行了检查，中位随访时间为12.1年。为了评估脉压和平均血压对未来需要治疗的高血压及心血管事件的预测价值，将参与者按压力三分位数分组。脉压的显著决定因素为男性（=0.029）、较年轻年龄（<0.001）、身体活动（=0.003）、心率（<0.001）、收缩期白大衣效应（<0.001）和每搏输出量（n = 829；<0.001）。在随访期间，65.1%的参与者发生了需要药物治疗的高血压，5.1%经历了心血管事件。与最低脉压三分位数组的参与者相比，最高脉压三分位数组的参与者发生高血压的风险降低（风险比，0.75；95%置信区间，0.62 - 0.91；=0.003）。相反，最高平均血压三分位数组的参与者风险增加（1.91；1.57 - 2.33；<0.001）。此外，最高脉压三分位数组的参与者发生心血管事件的风险降低（0.35；0.17 - 0.73；=0.005），而最高平均血压三分位数组的参与者风险增加（3.06；1.32 - 7.09；=0.009）。我们的数据表明，在45岁以下的受试者中，只有平均血压是不良结局的预测因素，而高脉压甚至具有降低的风险。
