National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Nutritional Epidemiology Lab, Pennsylvania State University, Philadelphia, PA, USA.
BMJ. 2018 Jun 5;361:k2158. doi: 10.1136/bmj.k2158.
To examine the associations of blood pressure with all cause mortality and cause specific mortality at three years among oldest old people in China.
Community based, longitudinal prospective study.
2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey, conducted in 22 Chinese provinces.
4658 oldest old individuals (mean age 92.1 years).
All cause mortality and cause specific mortality assessed at three year follow-up.
1997 deaths were recorded at three year follow-up. U shaped associations of mortality with systolic blood pressure, mean arterial pressure, and pulse pressure were identified; values of 143.5 mm Hg, 101 mm Hg, and 66 mm Hg conferred the minimum mortality risk, respectively. After adjustment for covariates, the U shaped association remained only for systolic blood pressure (minimum mortality risk at 129 mm Hg). Compared with a systolic blood pressure value of 129 mm Hg, risk of all cause mortality decreased for values lower than 107 mm Hg (from 1.47 (95% confidence interval 1.01 to 2.17) to 1.08 (1.01 to 1.17)), and increased for values greater than 154 mm Hg (from 1.08 (1.01 to 1.17) to 1.27 (1.02 to 1.58)). In the cause specific analysis, compared with a middle range of systolic blood pressure (107-154 mm Hg), higher values (>154 mm Hg) were associated with a higher risk of cardiovascular mortality (adjusted hazard ratio 1.51 (95% confidence interval 1.12 to 2.02)); lower values (<107 mm Hg) were associated with a higher risk of non-cardiovascular mortality (1.58 (1.26 to 1.98)). The U shaped associations remained in sensitivity and subgroup analyses.
This study indicates a U shaped association between systolic blood pressure and all cause mortality at three years among oldest old people in China. This association could be explained by the finding that higher systolic blood pressure predicted a higher risk of death from cardiovascular disease, and that lower systolic blood pressure predicted a higher risk of death from non-cardiovascular causes. These results emphasise the importance of revisiting blood pressure management or establishing specific guidelines for management among oldest old individuals.
在中国老年人中，研究血压与全因死亡率和特定原因死亡率的关系，随访时间为 3 年。
社区为基础的纵向前瞻性研究。
2011 年和 2014 年中国纵向健康长寿调查的两个波次，在中国 22 个省份进行。
4658 名高龄老年人（平均年龄 92.1 岁）。
在 3 年的随访中评估全因死亡率和特定原因死亡率。
在 3 年的随访中记录了 1997 例死亡。发现死亡率与收缩压、平均动脉压和脉压之间呈 U 型关联；收缩压 143.5mmHg、平均动脉压 101mmHg 和脉压 66mmHg 分别显示出最低的死亡率风险。在调整了混杂因素后，这种 U 型关联仍然只存在于收缩压（收缩压 129mmHg 时死亡率最低）。与收缩压值为 129mmHg 相比，收缩压值低于 107mmHg（从 1.47（95%置信区间 1.01 至 2.17）降至 1.08（1.01 至 1.17））的全因死亡率风险降低，而收缩压值高于 154mmHg（从 1.08（1.01 至 1.17）升至 1.27（1.02 至 1.58））的全因死亡率风险升高。在死因分析中，与收缩压的中值范围（107-154mmHg）相比，较高的收缩压值（>154mmHg）与心血管死亡率升高相关（调整后的危险比 1.51（95%置信区间 1.12 至 2.02））；较低的收缩压值（<107mmHg）与非心血管死亡率升高相关（1.58（1.26 至 1.98））。敏感性和亚组分析均显示出 U 型关联。
本研究表明，在中国高龄老年人中，收缩压与 3 年全因死亡率之间存在 U 型关联。这种关联可以通过以下发现来解释：较高的收缩压预示着死于心血管疾病的风险增加，而较低的收缩压预示着死于非心血管疾病的风险增加。这些结果强调了重新审视高龄老年人血压管理或制定特定管理指南的重要性。
