上臂与下臂收缩压与心血管结局：INTERPRESS-IPD 协作的个体参与者数据的荟萃分析。
Higher Arm Versus Lower Arm Systolic Blood Pressure and Cardiovascular Outcomes: a Meta-Analysis of Individual Participant Data From the INTERPRESS-IPD Collaboration.
机构信息
Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.).
Patient and Public Involvement Team, PenCLAHRC, University of Exeter Medical School, South Cloisters, Exeter, Devon, England (K.B.).
出版信息
Hypertension. 2022 Oct;79(10):2328-2335. doi: 10.1161/HYPERTENSIONAHA.121.18921. Epub 2022 Aug 2.
BACKGROUND
Guidelines recommend measuring blood pressure (BP) in both arms, adopting the higher arm readings for diagnosis and management. Data to support this recommendation are lacking. We evaluated associations of higher and lower arm systolic BPs with diagnostic and treatment thresholds, and prognosis in hypertension, using data from the Inter-arm Blood Pressure Difference-Individual Participant Data Collaboration.
METHODS
One-stage multivariable Cox regression models, stratified by study, were used to examine associations of higher or lower reading arm BPs with cardiovascular mortality, all-cause mortality, and cardiovascular events, in individual participant data meta-analyses pooled from 23 cohorts. Cardiovascular events were modelled for Framingham and atherosclerotic cardiovascular disease risk scores. Model fit was compared throughout using Akaike information criteria. Proportions reclassified across guideline recommended intervention thresholds were also compared.
RESULTS
We analyzed 53 172 participants: mean age 60 years; 48% female. Higher arm BP, compared with lower arm, reclassified 12% of participants at either 130 or 140 mm Hg systolic BP thresholds (both 0.001). Higher arm BP models fitted better for all-cause mortality, cardiovascular mortality, and cardiovascular events (all <0.001). Higher arm BP models better predicted cardiovascular events with Framingham and atherosclerotic cardiovascular disease risk scores (both <0.001) and reclassified 4.6% and 3.5% of participants respectively to higher risk categories compared with lower arm BPs).
CONCLUSIONS
Using BP from higher instead of lower reading arms reclassified 12% of people over thresholds used to diagnose hypertension. All prediction models performed better when using the higher arm BP. Both arms should be measured for accurate diagnosis and management of hypertension.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: CRD42015031227.
背景
指南建议测量双臂血压（BP），采用较高手臂的读数进行诊断和管理。缺乏支持这一建议的数据。我们使用来自双臂血压差异个体参与者数据协作的数据，评估了较高和较低手臂收缩压与高血压诊断和治疗阈值以及预后的关系。
方法
使用单阶段多变量 Cox 回归模型，按研究分层，在个体参与者数据荟萃分析中，检查较高或较低读数手臂 BP 与心血管死亡率、全因死亡率和心血管事件的关系，这些数据来自 23 个队列。使用 Framingham 和动脉粥样硬化性心血管疾病风险评分对心血管事件进行建模。使用赤池信息量准则比较整个模型的拟合情况。还比较了符合指南推荐干预阈值的再分类比例。
结果
我们分析了 53172 名参与者：平均年龄 60 岁；48%为女性。与较低手臂相比，较高手臂 BP 在 130 或 140mmHg 收缩压阈值下重新分类了 12%的参与者（均<0.001）。对于全因死亡率、心血管死亡率和心血管事件，较高手臂 BP 模型的拟合度更好（均<0.001）。较高手臂 BP 模型使用 Framingham 和动脉粥样硬化性心血管疾病风险评分更好地预测心血管事件（均<0.001），与较低手臂 BP 相比，分别有 4.6%和 3.5%的参与者被重新分类为更高的风险类别）。
结论
使用高于而不是低于读数手臂的 BP 重新分类了 12%超过用于诊断高血压的阈值的人。当使用较高手臂 BP 时，所有预测模型的性能都更好。为了准确诊断和管理高血压，应测量双臂血压。
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