Liu Menghui, Zhang Shaozhao, Chen Xiaohong, Zhong Xiangbin, Xiong Zhenyu, Yang Daya, Lin Yifen, Huang Yiquan, Li Yuqi, Wang Lichun, Zhuang Xiaodong, Liao Xinxue
Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, China.
Front Cardiovasc Med. 2021 Feb 15;8:632514. doi: 10.3389/fcvm.2021.632514. eCollection 2021.
The elevated blood pressure (BP) at midlife or late-life is associated with cardiovascular disease and death. However, there is limited research on the association between the BP patterns from middle to old age and incident coronary heart disease (CHD) and death. A cohort of the Atherosclerosis Risk in Communities (ARIC) Study enrolled 9,829 participants who attended five in-person visits from 1987 to 2013. We determined the association of mid- to late-life BP patterns with incident CHD and all-cause mortality using multivariable-adjusted Cox proportional hazards models. During a median of 16.7 years of follow-up, 3,134 deaths and 1,060 CHD events occurred. Compared with participants with midlife normotension, the adjusted hazard ratio for all-cause mortality and CHD was 1.14 (95% CI, 1.04-1.25) and 1.28 (95% CI, 1.10-1.50) in those with midlife hypertension, respectively. In further analyses, compared with a pattern of sustained normotension from mid- to late-life, there was no significant difference for the risk of incident death (HR, 1.15; 95% CI, 0.96-1.37) and CHD (HR, 1.33; 95% CI, 0.99-1.80) in participants with a pattern of midlife normotension and late-life hypertension with effective BP control. A higher risks of death and CHD were found in those with pattern of mid- to late-life hypertension with effective BP control (all-cause mortality: HR, 1.24; 95% CI, 1.08-1.43; CHD: HR, 1.65; 95% CI 1.30-2.09), pattern of midlife normotension and late-life hypertension with poor BP control (all-cause mortality: HR, 1.27; 95% CI, 1.12-1.44; CHD: HR, 1.53; 95% CI, 1.23-1.92), and pattern of mid- to late-life hypertension with poor BP control (all-cause mortality: HR, 1.49; 95% CI, 1.30-1.71; CHD: HR, 1.87; 95% CI, 1.48-2.37). The current findings underscore that the management of elderly hypertensive patients should not merely focus on the current BP status, but the middle-aged BP status. To achieve optimal reductions in the risk of CHD and death, it may be necessary to prevent, diagnose, and manage of hypertension throughout middle age.
中年或老年时血压升高与心血管疾病及死亡相关。然而，从中年到老年的血压模式与冠心病（CHD）发病及死亡之间关联的研究有限。社区动脉粥样硬化风险（ARIC）研究队列纳入了9829名参与者，他们在1987年至2013年间进行了五次面对面随访。我们使用多变量调整的Cox比例风险模型确定中年到老年血压模式与冠心病发病及全因死亡率之间的关联。在中位16.7年的随访期间，发生了3134例死亡和1060例冠心病事件。与中年血压正常者相比，中年高血压患者全因死亡率和冠心病的调整后风险比分别为1.14（95%CI，1.04 - 1.25）和1.28（95%CI，1.10 - 1.50）。在进一步分析中，与中年到老年持续血压正常的模式相比，中年血压正常且老年高血压但血压有效控制的参与者发生死亡（HR，1.15；95%CI，0.96 - 1.37）和冠心病（HR，1.33；95%CI，0.99 - 1.80）的风险无显著差异。在中年到老年高血压但血压有效控制的模式（全因死亡率：HR，1.24；95%CI，1.08 - 1.43；冠心病：HR，1.65；95%CI 1.30 - 2.09）、中年血压正常且老年高血压但血压控制不佳的模式（全因死亡率：HR，1.27；95%CI，1.12 - 1.44；冠心病：HR，1.53；95%CI，1.23 - 1.92）以及中年到老年高血压但血压控制不佳的模式（全因死亡率：HR，1.49；95%CI，1.30 - 1.71；冠心病：HR，1.87；95%CI，1.48 - 2.37）中，发现死亡和冠心病风险更高。当前研究结果强调，老年高血压患者的管理不应仅关注当前血压状况，还应关注中年时的血压状况。为了最大程度降低冠心病和死亡风险，可能有必要在整个中年时期预防、诊断和管理高血压。
