累积血压与心血管疾病长期风险的关联：来自 26 年的中国多省份队列研究-北京项目的结果。
Association between cumulative blood pressure and long-term risk of cardiovascular disease: findings from the 26-year Chinese Multi-provincial Cohort Study-Beijing Project.
机构信息
Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China.
Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing 100029, China.
出版信息
Chin Med J (Engl). 2021 Mar 1;134(8):920-926. doi: 10.1097/CM9.0000000000001383.
BACKGROUND
Cumulative blood pressure (BP), a measure incorporating the level and duration of BP exposure, is associated with the risk of cardiovascular disease (CVD). However, the level at which cumulative BP could significantly increase the risk remains unclear. This study aimed to investigate the association of 15-year cumulative BP levels with the long-term risk of CVD, and to examine whether the association is independent of BP levels at one examination.
METHODS
Data from a 26-year follow-up of the Chinese Multi-provincial Cohort Study-Beijing Project were analyzed. Cumulative BP levels between 1992 and 2007 were calculated among 2429 participants free of CVD in 2007. Cardiovascular events (including coronary heart disease and stroke) occurring from 2007 to 2018 were registered. Adjusted hazard ratios (HRs) for CVD incidence associated with quartiles of cumulative systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated.
RESULTS
Of the 2429 participants, 42.9% (1042) were men, and the mean age in 2007 was 62.1 ± 7.9 years. Totally, 207 CVD events occurred during the follow-up from 2007 to 2018. Participants with higher levels of cumulative SBP or DBP exhibited a higher incidence rate of CVD (P < 0.001). Compared with the lowest quartile of cumulative SBP, the HR for CVD was 1.03 (95% confidence interval [CI]: 0.59-1.81), 1.69 (95% CI: 0.99-2.87), and 2.20 (95% CI: 1.21-3.98) for the second to the fourth quartile of cumulative SBP, and 1.46 (95% CI: 0.86-2.48), 1.99 (95% CI: 1.18-3.35), and 2.08 (95% CI: 1.17-3.71) for the second to the fourth quartile of cumulative DBP, respectively. In further cross-combined group analyses with BP measurements in 2007, 15-year cumulative BP levels higher than the median, that is, 1970.8/1239.9 mmHg·year for cumulative SBP/DBP, which were equivalent to maintaining SBP/DBP levels of 131/83 mmHg or above on average in 15 years, were associated with higher risk of CVD in subsequent years independent of BP measurements at one-time point.
CONCLUSION
Cumulative exposure to moderate elevation of BP is independently associated with increased future cardiovascular risk.
背景
累积血压（cumulative blood pressure，BP）是一种综合血压水平和持续时间的指标，与心血管疾病（cardiovascular disease，CVD）的风险相关。然而，累积血压升高到何种程度会显著增加风险尚不清楚。本研究旨在探讨 15 年累积血压水平与长期 CVD 风险的关系，并检验该关联是否独立于单次血压测量值。
方法
对中国多省份队列研究-北京项目 26 年随访数据进行分析。2007 年无 CVD 的 2429 名参与者计算了 1992 年至 2007 年之间的累积血压水平。从 2007 年到 2018 年登记心血管事件（包括冠心病和中风）的发生情况。计算累积收缩压（systolic blood pressure，SBP）和舒张压（diastolic blood pressure，DBP）四分位数与 CVD 发生率相关的调整后的危险比（hazard ratios，HRs）。
结果
在 2429 名参与者中，42.9%（1042 名）为男性，2007 年的平均年龄为 62.1±7.9 岁。2007 年至 2018 年的随访期间共发生 207 例 CVD 事件。累积 SBP 或 DBP 水平较高的参与者 CVD 发生率较高（P<0.001）。与累积 SBP 的最低四分位数相比，累积 SBP 第二至第四四分位数的 CVD 风险 HR 分别为 1.03（95%置信区间 [CI]：0.59-1.81）、1.69（95% CI：0.99-2.87）和 2.20（95% CI：1.21-3.98），累积 DBP 的第二至第四四分位数的 CVD 风险 HR 分别为 1.46（95% CI：0.86-2.48）、1.99（95% CI：1.18-3.35）和 2.08（95% CI：1.17-3.71）。在进一步的交叉组合组分析中，2007 年的 BP 测量值与累积 BP 水平高于中位数（即累积 SBP/DBP 为 1970.8/1239.9mmHg·年），这相当于在 15 年内平均维持 SBP/DBP 水平在 131/83mmHg 或以上，与随后几年 CVD 风险升高相关，而与单次点的 BP 测量值无关。
结论
中度升高的累积血压暴露与未来心血管风险增加独立相关。
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