Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Department of Kinesiology and Health Education, University of Texas at Austin, USA.
Eur J Prev Cardiol. 2020 Jan;27(1):51-59. doi: 10.1177/2047487319865378. Epub 2019 Jul 30.
The aim of this study was to evaluate the associations of blood pressure categorization based on the 2017 American College of Cardiology and American Heart Association guideline with the risk of peripheral artery disease (PAD).
Among 13,113 middle-aged participants, we investigated the associations of 2017 blood pressure categories (systolic <120 and diastolic <80 mmHg (normal if no anti-hypertensive medications; reference), 120-129 and <80 (elevated), 130-139 and/or 80-89 (stage 1 hypertension), and ≥140 and/or ≥90 (stage 2 hypertension)) with incident PAD (hospitalizations with a diagnosis or leg revascularization) using Cox regression models. Analyses were separately conducted in individuals with and without anti-hypertensive medications.
During a median follow-up of 25.4 years, 466 incident PAD occurred (271 cases in 9858 participants without anti-hypertensive medications). In participants without anti-hypertensive medications, we observed significant hazard ratios of PAD in elevated blood pressure (1.80 (1.28-2.51)) and stage 2 hypertension (2.40 (1.72-3.34)), but not in stage 1 hypertension. Analyzing systolic and diastolic blood pressure separately, higher systolic blood pressure categories showed significant associations with incident PAD in a graded fashion whereas, for diastolic blood pressure, only ≥90 mmHg did. Generally similar patterns were seen among participants on anti-hypertensive medication, while they had higher risk of PAD than those without at each blood pressure category.
Systolic blood pressure, including the category of 130-139 mmHg, showed stronger associations with incident PAD than did diastolic blood pressure. Consequently, elevated blood pressure conferred similar or even greater risk of PAD than stage 1 hypertension, with implications on how to interpret new blood pressure categories in terms of leg vascular health.
本研究旨在评估基于 2017 年美国心脏病学会和美国心脏协会指南的血压分类与外周动脉疾病（PAD）风险的相关性。
在 13113 名中年参与者中，我们使用 Cox 回归模型研究了 2017 年血压分类（收缩压<120mmHg 和舒张压<80mmHg（无抗高血压药物时为正常；参考）、120-129mmHg 和<80mmHg（升高）、130-139mmHg 和/或 80-89mmHg（1 期高血压）和≥140mmHg 和/或≥90mmHg（2 期高血压））与 PAD（诊断为住院或腿部血运重建的事件）发生的相关性。在有和没有抗高血压药物的个体中分别进行分析。
在中位随访 25.4 年期间，发生了 466 例 PAD 事件（9858 名无抗高血压药物的参与者中有 271 例）。在无抗高血压药物的参与者中，我们观察到升高的血压（1.80（1.28-2.51））和 2 期高血压（2.40（1.72-3.34））与 PAD 的显著危险比，但 1 期高血压则没有。分别分析收缩压和舒张压，较高的收缩压类别与 PAD 的发生呈分级关联，而对于舒张压，只有≥90mmHg 与 PAD 相关。在服用抗高血压药物的参与者中，也观察到了类似的模式，尽管他们在每个血压类别中发生 PAD 的风险都高于无抗高血压药物的参与者。
收缩压，包括 130-139mmHg 的类别，与 PAD 的发生比舒张压更强相关。因此，升高的血压与 PAD 的相关性与 1 期高血压相似，甚至更大，这对如何根据腿部血管健康来解释新的血压类别有影响。
