Cheng Jing, Yang Bo, Ma Ru-Lin, He Jia, Rui Dong-Sheng, Li Yu, Zhang Xiang-Hui, Jian Le-Yao, Li Jia-Hang, Guo Shu-Xia, Guo Heng
Department of Public Health, Shihezi University School of Medicine, North 2th Road, Shihezi, Xinjiang, 832003, China.
Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Shihezi University, Shihezi, Xinjiang, 832000, China.
BMC Public Health. 2025 Mar 31;25(1):1214. doi: 10.1186/s12889-025-22069-9.
This study aimed to explore and compare the role of cumulative exposure to four blood pressure (BP) markers [systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP)] in predicting cardiovascular disease (CVD) risk in the Uyghur population.
We recruited 3,553 Uyghurs from Tumxuk City, and conducted blood pressure measurements on them at least three times, with a minimum interval of two years between consecutive measurements. Cumulative BP was defined as the sum of the product of the average BP between consecutive examinations and the time interval between visits. Cox proportional hazard models and restricted cubic spline (RCS) analysis were used to estimate the association between cumBP and CVD risk. The incremental predictive value of cumBP was further assessed using the net reclassification index (NRI) and integrated discrimination improvement (IDI).
Over a median follow-up of 6.29 years, 383 (10.78%) incidents of CVD occurred. All four cumBP markers were associated with CVD risk, with cumulative SBP (cumSBP) and cumulative PP (cumPP) showing the strongest associations. For each 1-SD increase in cumSBP and cumPP, the CVD risk increased by 31% [HR (95% CI): 1.310 (1.153, 1.489)] and 28% [HR (95% CI): 1.284 (1.132, 1.457)], respectively. Additionally, 1-SD values corresponded to 107.90 mmHg·years for cumSBP and 65.33 mmHg·years for cumPP. RCS analysis showed a linear relationship between cumBP and CVD risk. CumSBP provided the best incremental predictive value for CVD after adding cumSBP to the conventional model, improving the NRI by 0.126 (P = 0.019) and the IDI by 0.009 (P = 0.001). Although cumulative MAP and cumulative PP also improved the predictive capabilities to varying degrees, the effect sizes were smaller than those of cumSBP.
All four cumBP markers were significantly associated with CVD risk in this population. Compared with the other three cumBP measures, cumSBP had the strongest association with CVD events and provided a superior incremental predictive value for CVD events.
本研究旨在探讨和比较四种血压指标[收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）和脉压（PP）]的累积暴露量在预测维吾尔族人群心血管疾病（CVD）风险中的作用。
我们从图木舒克市招募了3553名维吾尔族人，并对他们进行了至少三次血压测量，连续测量之间的最短间隔为两年。累积血压定义为连续两次检查之间的平均血压与就诊时间间隔的乘积之和。采用Cox比例风险模型和受限立方样条（RCS）分析来估计累积血压与CVD风险之间的关联。使用净重新分类指数（NRI）和综合判别改善（IDI）进一步评估累积血压的增量预测价值。
在中位随访6.29年期间，发生了383例（10.78%）CVD事件。所有四种累积血压指标均与CVD风险相关，累积收缩压（cumSBP）和累积脉压（cumPP）显示出最强的关联。cumSBP和cumPP每增加1个标准差，CVD风险分别增加31%[风险比（95%置信区间）：1.310（1.153，1.489）]和28%[风险比（95%置信区间）：1.284（1.132，1.457）]。此外，1个标准差的值对于cumSBP相当于107.90mmHg·年，对于cumPP相当于65.33mmHg·年。RCS分析显示累积血压与CVD风险之间呈线性关系。在传统模型中加入cumSBP后，cumSBP为CVD提供了最佳的增量预测价值，使NRI提高了0.126（P = 0.019），IDI提高了0.009（P = 0.001）。虽然累积平均动脉压和累积脉压也不同程度地提高了预测能力，但其效应大小小于cumSBP。
在该人群中，所有四种累积血压指标均与CVD风险显著相关。与其他三种累积血压测量指标相比，cumSBP与CVD事件的关联最强，并为CVD事件提供了更高的增量预测价值。
