Kim Min-Sik, Kim Gee-Hee
Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Front Cardiovasc Med. 2022 Oct 19;9:990748. doi: 10.3389/fcvm.2022.990748. eCollection 2022.
Hypertension (HBP) is a common disease among both men and women. Central blood pressure (CBP) is a method of evaluating aorta pressure that can assess the intrinsic BP of an individual patient that more closely correlates with cardiovascular disease (CVD) outcomes than peripheral BP parameters. We evaluated gender-specific differences in CBP and optimal target BP based on a composite outcome of CVD, heart failure (HF), and hypertensive complications in patients with HBP.
Patients were enrolled from June 2011 to December 2015 and were followed through December 2019. CBP was measured using radial tonometry. The primary endpoint was a composite outcome.
The median follow-up period for enrolled patients was 6.5 years. Out of a total of 2,115 patients with an average age of 57.9 ± 13.6 years, 266 patients (12.6%) had events of primary end points during the follow-up period. There was no difference in the lowest BP level between men and women in the incidence of CVD. Among the women (49.6%), 78.1% were postmenopausal. In a multivariable Cox proportional hazards model, CBP and systolic BP showed an increase in risk of 10 and 11%, respectively, with every 10 mmHg increase, and there was a similar trend of 12 and 13%, respectively, in postmenopausal women. However, PP showed an increase in risk of about 2% every 10 mmHg increase, but a tendency to increase risk by 19% in postmenopausal women.
This study demonstrated that postmenopausal women will continue to show increased risk for CVD at BP higher than the optimal level. Conversely, there was no increase in CV risk due to menopause at BP values below the optimal level. Therefore, well-controlled BP is more important in postmenopausal women.
高血压在男性和女性中都是一种常见疾病。中心血压（CBP）是一种评估主动脉压力的方法，它可以评估个体患者的内在血压，与外周血压参数相比，其与心血管疾病（CVD）结局的相关性更强。我们基于CVD、心力衰竭（HF）和高血压患者高血压并发症的综合结局，评估了CBP和最佳目标血压的性别差异。
患者于2011年6月至2015年12月入组，并随访至2019年12月。使用桡动脉压计测量CBP。主要终点是综合结局。
入组患者的中位随访期为6.5年。在总共2115例平均年龄为57.9±13.6岁的患者中，266例（12.6%）在随访期间发生了主要终点事件。在CVD发病率方面，男性和女性的最低血压水平没有差异。在女性（49.6%）中，78.1%为绝经后女性。在多变量Cox比例风险模型中，CBP和收缩压每升高10 mmHg，风险分别增加10%和11%，绝经后女性中分别有类似的12%和13%的趋势。然而，脉压每升高10 mmHg，风险增加约2%，但在绝经后女性中风险增加趋势为19%。
本研究表明，绝经后女性在血压高于最佳水平时，CVD风险将持续增加。相反，在血压值低于最佳水平时，绝经不会增加心血管风险。因此，血压得到良好控制对绝经后女性更为重要。
