State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Division of Cardiology, The Fifth Hospital of Wuhan & Cardiovascular Institute of Jianghan University, Wuhan, China.
Hypertens Res. 2022 Dec;45(12):1882-1890. doi: 10.1038/s41440-022-01030-y. Epub 2022 Sep 20.
Numerous trials have shown that lowering blood pressure (BP) reduces cardiovascular risk and mortality, yet data about the impact of BP on cardiovascular death risk in patients aged ≥80 years with acute myocardial infarction (AMI) are sparse. This study explored the prognostic value of BP for cardiovascular death during the first 48 h after admission following AMI among patients aged ≥80 years. A total of 1005 patients ≥80 years with AMI were enrolled. Average BP parameters, including systolic, diastolic, and pulse BP, over the first 48 h after admission were calculated. The end point was cardiovascular death. Receiver operating curve (ROC) analysis was used to identify whether BP was relevant to cardiovascular death. The relationship between BP levels and cardiovascular death was evaluated by Cox regression models. ROC analysis showed that average diastolic blood pressure (aDBP), but not systolic and pulse BP, was relevant to cardiovascular death, and the optimal cutoff was 65 mmHg. During the 2.9-year follow-up, patients who died from a cardiovascular cause had lower aDBP levels than those who did not (p = 0.002). Patients with aDBP <65 mmHg had a 1.5-fold higher incidence of cardiovascular death than those with aDBP ≥65 mmHg (35.9% vs. 24.0%; p < 0.001). In multivariable regression analysis, low aDBP remained a strong and independent predictor of cardiovascular death (adjusted hazard ratio 1.907; 95% CI 1.303-2.792). aDBP was independently associated with cardiovascular death in patients aged ≥80 years with AMI, suggesting that aDBP may be a useful index to predict worse outcome in these patients.
大量试验表明，降低血压（BP）可降低心血管风险和死亡率，但关于急性心肌梗死（AMI）患者中≥80 岁人群的 BP 对心血管死亡风险影响的数据却很少。本研究探讨了 AMI 患者入院后 48 小时内的 BP 对心血管死亡的预测价值。共纳入 1005 例≥80 岁 AMI 患者。计算了入院后 48 小时内的平均 BP 参数，包括收缩压、舒张压和脉压。终点是心血管死亡。采用受试者工作特征曲线（ROC）分析确定 BP 是否与心血管死亡相关。通过 Cox 回归模型评估 BP 水平与心血管死亡的关系。ROC 分析表明，平均舒张压（aDBP）而非收缩压和脉压与心血管死亡相关，最佳截断值为 65mmHg。在 2.9 年的随访期间，死于心血管原因的患者的 aDBP 水平低于未死于心血管原因的患者（p=0.002）。aDBP<65mmHg 的患者心血管死亡的发生率是 aDBP≥65mmHg 的患者的 1.5 倍（35.9%比 24.0%；p<0.001）。在多变量回归分析中，低 aDBP 仍然是心血管死亡的一个强有力的独立预测因素（调整后的危险比 1.907；95%CI 1.303-2.792）。aDBP 与≥80 岁 AMI 患者的心血管死亡独立相关，表明 aDBP 可能是预测这些患者预后较差的有用指标。
