From the Cardiology and Physiology Departments, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat and Paris Diderot University, Sorbonne Paris Cité, France (E.V.-P., P.G.S.); INSERM U1149, Centre de Recherche sur l'Inflammation, Paris, France (E.V.-P.); Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (N.G., I.F.); Centro Cardiologico Universitario di Ferrara, University of Ferrara, and Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy (R.F.); National Heart and Lung Institute, Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London, United Kingdom (K.M.F., P.G.S.); Department of Medicine, Montreal Heart Institute, Université de Montreal, Canada (J.-C.T.); Medical University of Silesia, School of Medicine in Katowice, Department of Cardiology and Structural Heart Disease, Poland (M.T.); Emergency Cardiology Department, Institute of Cardiology, Kiev, Ukraine (A.P.); Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); and French Alliance for Cardiovascular Trials, an F-CRIN network, INSERM U1148, Laboratory for Vascular Translational Science, Paris, France (P.G.S.).
Hypertension. 2018 Jan;71(1):168-176. doi: 10.1161/HYPERTENSIONAHA.117.10204. Epub 2017 Oct 30.
Observational studies have shown a J-shaped relationship between diastolic blood pressure (BP) and cardiovascular events in hypertensive patients with coronary artery disease. We investigated whether the increased risk associated with low diastolic BP reflects elevated pulse pressure (PP). In 22 672 hypertensive patients with coronary artery disease from the CLARIFY registry (Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease), followed for a median of 5.0 years, BP was measured annually and averaged. The relationships between PP and diastolic BP, alone or combined, and the primary composite outcome (cardiovascular death or myocardial infarction) were analyzed using multivariable Cox proportional hazards models. Adjusted hazard ratios for the primary outcome were 1.62 (95% confidence interval [CI], 1.40-1.87), 1.00 (ref), 1.07 (95% CI, 0.94-1.21), 1.54 (95% CI, 1.32-1.79), and 2.34 (95% CI, 1.95-2.81) for PP<45, 45 to 54 (reference), 55 to 64, 65 to 74, and ≥75 mm Hg, respectively, and 1.50 (95% CI, 1.31-1.72), 1.00 (reference), and 1.58 (95% CI, 1.42-1.77) for diastolic BPs of <70, 70 to 79 (ref), and ≥80 mm Hg, respectively. In a cross-classification analysis between diastolic BP and PP, the relationship between diastolic BP and the primary outcome remained J-shaped when the analysis was restricted to patients with the lowest-risk PP (45-64 mm Hg), with adjusted hazard ratios of 1.53 (95% CI, 1.27-1.83), 1.00 (ref), and 1.54 (95% CI, 1.34-1.75) in the <70, 70 to 79 (reference), and ≥80 mm Hg subgroups, respectively. The J-shaped relationship between diastolic BP and cardiovascular events in hypertensive patients with coronary artery disease persists in patients within the lowest-risk PP range and is therefore unlikely to be solely the consequence of an increased PP reflecting advanced vascular disease.
URL: http://www.clarify-registry.com. Unique identifier: ISRCTN43070564.
观察性研究表明，在患有冠状动脉疾病的高血压患者中，舒张压（BP）与心血管事件之间存在 J 形关系。我们研究了与低舒张压相关的风险增加是否反映了脉压（PP）升高。在 CLARIFY 注册中心（稳定型冠状动脉疾病患者前瞻性观察性纵向登记处）的 22672 例患有冠状动脉疾病的高血压患者中，中位随访时间为 5.0 年，每年测量一次血压并进行平均处理。使用多变量 Cox 比例风险模型分析了 PP 与舒张压之间的单独或联合关系，以及主要复合结局（心血管死亡或心肌梗死）。主要结局的调整后风险比分别为 1.62（95%置信区间 [CI]，1.40-1.87）、1.00（参考值）、1.07（95%CI，0.94-1.21）、1.54（95%CI，1.32-1.79）和 2.34（95%CI，1.95-2.81），PP<45mmHg、45-54mmHg（参考值）、55-64mmHg、65-74mmHg 和≥75mmHg，舒张压分别为<70mmHg、70-79mmHg（参考值）和≥80mmHg，分别为 1.50（95%CI，1.31-1.72）、1.00（参考值）和 1.58（95%CI，1.42-1.77）。在舒张压和 PP 之间的交叉分类分析中，当分析仅限于最低风险 PP（45-64mmHg）的患者时，舒张压与主要结局之间的关系仍然呈 J 形，调整后的风险比分别为 1.53（95%CI，1.27-1.83）、1.00（参考值）和 1.54（95%CI，1.34-1.75），在<70mmHg、70-79mmHg（参考值）和≥80mmHg 亚组中分别为 1.53（95%CI，1.27-1.83）、1.00（参考值）和 1.54（95%CI，1.34-1.75）。在患有冠状动脉疾病的高血压患者中，舒张压与心血管事件之间的 J 形关系在最低风险 PP 范围内的患者中仍然存在，因此不太可能仅仅是由于脉压升高反映了晚期血管疾病所致。
