Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Public Health. 2022 Oct 4;10:1006220. doi: 10.3389/fpubh.2022.1006220. eCollection 2022.
Traditional risk estimations for cardiovascular disease (CVD) are based on current blood pressure (BP); however, whether cumulative exposure to elevated BP among rural individuals has additional prognostic value is unclear. We aimed to validate the association of cumulative BP with CVD occurrence and assess the prognostic value of cumulative BP in CVD risk prediction.
A total of 13,057 participants who underwent three examinations from 2004 to 2010 were included in this rural epidemiological study and followed up until 2017. Cumulative BP was defined as the sum of the product of the average BP values between consecutive examinations and the time interval for each pair of successive tests prior to the follow-up period. CVD incidents that occurred during the follow-up period were noted and verified by qualified researchers. We used multivariate Cox models to assess the association of cumulative BP with CVD risk. The receiver operating characteristic curve was constructed to determine the predictive differentiation of single baseline BP measurements and cumulative BP values for CVD outcomes.
During the follow-up period, 1,312 participants underwent CVD incidents. We found that cumulative systolic BP (hazard ratio = 1.334, 95% confidence interval: 1.245, 1.430) and cumulative diastolic BP (hazard ratio = 1.253, 95% confidence interval: 1.168, 1.343) were associated with CVD incidence above and beyond that of the current BP. These stronger associations persisted for stroke, myocardial infarction, and CVD mortality. The area under the curve for the model increased significantly ( < 0.001) from 0.735 (0.720, 0.750) to 0.742 (0.728, 0.757) when integrating cumulative systolic BP instead of baseline systolic BP.
Cumulative BP in Chinese rural adults showed a stronger association with CVD incidence than that of current BP. Furthermore, cumulative BP slightly improved the predictive performance for CVD. Our findings underline the incremental predictive value of cumulative BP in CVD risk assessment among Chinese rural adults.
传统的心血管疾病（CVD）风险评估基于当前血压（BP）；然而，农村个体中升高的 BP 累积暴露是否具有额外的预后价值尚不清楚。我们旨在验证累积 BP 与 CVD 发生的相关性，并评估累积 BP 在 CVD 风险预测中的预后价值。
这项农村流行病学研究共纳入了 13057 名参与者，他们在 2004 年至 2010 年期间接受了三次检查，并随访至 2017 年。累积 BP 定义为随访期间每对连续检查之间的平均 BP 值与每对连续检查之间的时间间隔的乘积之和。随访期间发生的 CVD 事件由合格的研究人员记录和验证。我们使用多变量 Cox 模型评估累积 BP 与 CVD 风险的相关性。构建受试者工作特征曲线以确定单基线 BP 测量值和累积 BP 值对 CVD 结局的预测区分能力。
在随访期间，有 1312 名参与者发生了 CVD 事件。我们发现，累积收缩压（危险比=1.334，95%置信区间：1.245，1.430）和累积舒张压（危险比=1.253，95%置信区间：1.168，1.343）与 CVD 发生率的相关性强于当前 BP。这些更强的相关性在中风、心肌梗死和 CVD 死亡率中仍然存在。当整合累积收缩压而不是基线收缩压时，模型的曲线下面积显著增加（<0.001），从 0.735（0.720，0.750）增加到 0.742（0.728，0.757）。
中国农村成年人的累积 BP 与 CVD 发生率的相关性强于当前 BP，并且累积 BP 略微提高了 CVD 的预测性能。我们的研究结果强调了累积 BP 在评估中国农村成年人 CVD 风险中的增量预测价值。
