无心血管疾病成年人的收缩压与舒张压、心脏生物标志物及心血管死亡率
Systolic and Diastolic Blood Pressure, Cardiac Biomarkers, and Cardiovascular Mortality in Adults Without Cardiovascular Disease.
作者信息
Guo Junchen, Liu Yan, Liu Xiaoxuan, Yan Miao, Zhang Yiying, Fang Shaohong, Wang Shanjie, Yu Bo
机构信息
State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Harbin, China; Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
Department of Epidemiology and Biostatistics, School of Public Health, Jiamusi University, Jiamusi, China.
出版信息
JACC Adv. 2025 Mar 27;4(5):101678. doi: 10.1016/j.jacadv.2025.101678.
BACKGROUND
Whether cardiac biomarkers can help provide insights into optimal blood pressure (BP) and BP-related cardiovascular mortality risk is compelling.
OBJECTIVES
The purpose of this study was to evaluate 1) the associations between systolic and diastolic blood pressure (SBP, DBP) and cardiac biomarkers; and 2) their association with cardiovascular mortality in adults without cardiovascular disease.
METHODS
Cross-sectional associations between SBP, DBP and cardiac biomarkers (high-sensitivity cardiac troponin T [hs-cTnT], N-terminal pro-brain natriuretic peptide [NT-proBNP], and high-sensitivity cardiac troponin I), and prospective associations with cardiovascular mortality were analyzed using the 1999 to 2004 U.S. National Health and Nutrition Examination Survey. Prevalence rate ratio (PRR)/incidence rate ratio was estimated using weighted Poisson regression models. SBP was defined as ≥130 mm Hg, DBP was defined as <70 mm Hg; and TNT was defined as ≥14 ng/L.
RESULTS
Among 11,242 adults, 2,355 deaths occurred during a median follow-up of 17.5 (IQR: 15.6-20.5) years. Compared with the reference group SBP 120 to 129 mm Hg, SBP ≥160 mm Hg had a nearly 2-fold higher adjusted PRR for hs-cTnT (1.76 [95% CI: 1.35-2.29]) and NT-proBNP (1.86 [95% CI: 1.59-2.17]). Compared with the reference group DBP 70 to 79 mm Hg, those with DBP <50 mm Hg had higher PRR for hs-cTnT (1.76 [1.39-2.23]) and NT-proBNP (1.41 [95% CI: 1.22-1.63]). Treating normal DBP, SBP, and low hs-cTnT as reference, incidence rate ratios (95% CIs) for cardiovascular mortality in SBPTNT was 2.39 (95% CI: 1.74-3.29) and for DBPTNT was 2.27 (95% CI: 1.62-3.18).
CONCLUSIONS
Low DBP levels (<70 mm Hg) and high SBP (≥130 mm Hg) were independently associated with increased hs-cTnT or NT-proBNP. Their associations with cardiovascular mortality varied according to the presence of subclinical myocardial injury (hs-cTnT level). The combination of BP and cardiac biomarkers helps identify those at highest risk.
背景
心脏生物标志物能否有助于深入了解最佳血压（BP）及与血压相关的心血管死亡风险，这一问题备受关注。
目的
本研究旨在评估1）收缩压和舒张压（SBP、DBP）与心脏生物标志物之间的关联；2）它们与无心血管疾病成年人的心血管死亡之间的关联。
方法
利用1999年至2004年美国国家健康和营养检查调查，分析SBP、DBP与心脏生物标志物（高敏心肌肌钙蛋白T [hs-cTnT]、N末端脑钠肽前体[NT-proBNP]和高敏心肌肌钙蛋白I）之间的横断面关联，以及与心血管死亡的前瞻性关联。使用加权泊松回归模型估计患病率比（PRR）/发病率比。SBP定义为≥130 mmHg，DBP定义为<70 mmHg；TNT定义为≥14 ng/L。
结果
在11242名成年人中，中位随访17.5（四分位间距：15.6 - 20.5）年期间有2355人死亡。与SBP为120至129 mmHg的参照组相比，SBP≥160 mmHg时hs-cTnT的校正PRR高近2倍（1.76 [95%置信区间：1.35 - 2.29]），NT-proBNP的校正PRR为1.86（95%置信区间：1.59 - 2.17）。与DBP为70至79 mmHg的参照组相比，DBP<50 mmHg者hs-cTnT的PRR较高（1.76 [1.39 - 2.23]），NT-proBNP的PRR为1.41（95%置信区间：1.22 - 1.63）。将正常DBP、SBP和低hs-cTnT作为参照，SBPTNT组心血管死亡的发病率比（95%置信区间）为2.39（95%置信区间：1.74 - 3.29），DBPTNT组为2.27（95%置信区间：1.62 - 3.18）。
结论
低DBP水平（<70 mmHg）和高SBP（≥130 mmHg）与hs-cTnT或NT-proBNP升高独立相关。它们与心血管死亡的关联因亚临床心肌损伤（hs-cTnT水平）的存在而异。血压与心脏生物标志物的联合有助于识别风险最高的人群。
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