Liu Jian, Ma Xuehua, Ren Xue-Ling, Xiao Hong, Yan Leyuan, Li Zhuorong, Wang Shengshu
Department of Healthcare, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
Department of Respiratory, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, China.
Front Physiol. 2021 Aug 23;12:690094. doi: 10.3389/fphys.2021.690094. eCollection 2021.
Although high blood pressure (BP) is a risk factor for carotid plaque, its long-term prognostic value might be underestimated due to its confounding interactions with BMI, age, and gender. Therefore, we conducted a 7-year prospective cohort study to evaluate the prognostic value of BP for the incidence of carotid plaque. The subjects enrolled in 2011 were free of carotid plaque at baseline and were followed up in 2018. Multivariate Cox proportional-hazards models were used to evaluate the association between BP and carotid plaque incidence. During the follow-up study, the incidence of carotid plaque was 36.5%. The significant positive linear trend showed that subjects with higher BP levels at baseline were more likely to develop carotid plaques at the end. Especially in the female subpopulation, after confounders being adjusted, the carotid plaque was associated with higher BP (adjusted HR 1.52, 95% CI 1.02-2.26), pulse pressure (PP) (adjusted HR 1.15, 95% CI 0.76-1.75), and mean arterial pressure (MAP) (adjusted HR 1.44, 95% CI 1.00-2.08). The adjusted HRs of hypertension, PP, and MAP (HR 27.71, 95% CI 2.27-338.64; HR 14.47, 95% CI 1.53-137.18; HR 9.97, 95% CI 1.29-77.28) were significantly higher after the potential antagonistic interactions between BP categorical indicators and age being adjusted, respectively. High BP indicators might be associated with higher HRs of carotid plaque after adjusting interactions between BP indicators and BMI, age, and gender, which suggests that the incidence of carotid plaque in female adults with high BP indicators might increase significantly with the increase of age.
虽然高血压是颈动脉斑块的一个危险因素，但其长期预后价值可能因与体重指数、年龄和性别的混杂相互作用而被低估。因此，我们进行了一项为期7年的前瞻性队列研究，以评估血压对颈动脉斑块发生率的预后价值。2011年纳入的受试者在基线时无颈动脉斑块，并于2018年进行随访。采用多变量Cox比例风险模型评估血压与颈动脉斑块发生率之间的关联。在随访研究中，颈动脉斑块的发生率为36.5%。显著的正线性趋势表明，基线血压水平较高的受试者最终更有可能发生颈动脉斑块。特别是在女性亚组中，在调整混杂因素后，颈动脉斑块与较高的血压（调整后风险比1.52，95%置信区间1.02 - 2.26）、脉压（PP）（调整后风险比1.15，95%置信区间0.76 - 1.75）和平均动脉压（MAP）（调整后风险比1.44，95%置信区间1.00 - 2.08）相关。在分别调整血压分类指标与年龄之间的潜在拮抗相互作用后，高血压、PP和MAP的调整后风险比（风险比27.71，95%置信区间2.27 - 338.64；风险比14.47，95%置信区间1.53 - 137.18；风险比9.97，95%置信区间1.29 - 77.28）显著更高。在调整血压指标与体重指数、年龄和性别之间的相互作用后，高血压指标可能与颈动脉斑块的较高风险比相关联，这表明血压指标高的成年女性中颈动脉斑块的发生率可能随着年龄的增长而显著增加。
