Miao Congliang, Zhao Dandan, Chen Shuohua, Xu Lina, Huang Yusong, Li Huimin, Deng Huibiao, Wu Lili, Wang Yuchen, Fu Yu, Wu Guoyan, Wu Shouling, Hong Jiang, Yang Wen-Yi
Department of Internal and Emergency Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Emergency Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
J Clin Hypertens (Greenwich). 2025 Apr;27(4):e70043. doi: 10.1111/jch.70043.
Pulse pressure (PP) is a recognized marker of cardiovascular risk in the general population. However, its role as an independent predictor of recurrent cardiovascular events following myocardial infarction (MI) and whether there are age-dependent differences in this relationship remains uncertain. We analyzed data from 4091 participants with a history of MI were enrolled in the Kailuan Study. Univariate and multivariable Cox models were used to analyze the associations between PP and primary outcome (composite cardiovascular events, a composite of all-cause death, nonfatal recurrent MI, nonfatal hospitalization for heart failure or nonfatal stroke) and secondary outcomes (each individual components of composite endpoint) after MI. Over a median follow-up of 7.8 years, 1610 composite cardiovascular events occurred. The mean baseline PP was 54.2 ± 16.1 mmHg. Compared with individuals in the first PP quartile, those in the fourth quartile had significantly greater risks of composite cardiovascular events (adjusted HR: 1.20; 95% CI: 1.03-1.41; p = 0.02) and recurrent MI (adjusted HR: 1.56; 95% CI: 1.03-2.36; p = 0.04). A linear, dose-response relationship was observed between PP and the risk of adverse cardiovascular outcomes (all p ≤ 0.02), except for stroke (p = 0.36). Subgroup analyses indicated that the association between PP and adverse outcomes was stronger among participants aged <60 years compared with older individuals. Elevated PP is an independent predictor of recurrent cardiovascular outcomes in post-MI patients, with particularly stronger associations observed in younger and middle-aged adults. Trial Registration: ChiCTR-TNRC-11001489.
脉压（PP）是一般人群心血管风险的公认标志物。然而，其作为心肌梗死（MI）后心血管事件复发的独立预测因子的作用，以及这种关系是否存在年龄依赖性差异仍不确定。我们分析了开滦研究中4091名有MI病史参与者的数据。采用单变量和多变量Cox模型分析MI后PP与主要结局（复合心血管事件，包括全因死亡、非致死性复发性MI、因心力衰竭或非致死性卒中的非致死性住院的复合结局）和次要结局（复合终点的各个单独组成部分）之间的关联。在中位随访7.8年期间，发生了1610例复合心血管事件。平均基线PP为54.2±16.1 mmHg。与处于第一PP四分位数的个体相比，处于第四四分位数的个体发生复合心血管事件的风险显著更高（调整后HR：1.20；95%CI：1.03 - 1.41；p = 0.02）以及复发性MI（调整后HR：1.56；95%CI：1.03 - 2.36；p = 0.04）。除卒中外（p = 0.36），在PP与不良心血管结局风险之间观察到线性剂量反应关系（所有p≤0.02）。亚组分析表明，与老年个体相比，PP与不良结局之间的关联在年龄<60岁的参与者中更强。升高的PP是MI后患者心血管结局复发的独立预测因子，在年轻和中年成年人中观察到的关联尤为更强。试验注册号：ChiCTR - TNRC - 11001489。
