Dyer A R, Stamler J, Shekelle R B, Schoenberger J A, Stamler R, Shekelle S, Berkson D M, Paul O, Lepper M H, Lindberg H A
J Chronic Dis. 1982;35(4):259-73. doi: 10.1016/0021-9681(82)90082-0.
Because systolic blood pressure rises more sharply than diastolic blood pressure for those middle aged and beyond, leading to an increasing prevalence with advancing age of elevated systolic blood pressure without elevated diastolic pressure, i.e. so-called pure systolic hypertension, the question arises as to whether or not factors that have been shown to be related to blood pressure and hypertension are related to pure systolic hypertension or to 'classical' hypertension, i.e. hypertension defined solely by the level of the diastolic pressure. This question was examined in four Chicago epidemiologic studies by examining the associations between several variables and pulse pressure, with pulse pressure redefined so that the association between a variable and pulse pressure indicated whether the variable was more strongly related to systolic or diastolic blood pressure. In these four studies, glucose, heart rate and cigarette use tended to show a stronger association with systolic pressure, suggesting a possible association with pure systolic hypertension, while hematocrit, serum cholesterol, and uric acid tended to be more strongly associated with diastolic pressure, or equally associated with systolic and diastolic pressure, suggesting an association with 'classical' hypertension. Relative weight tended to be more strongly associated with systolic pressure under the age of 35 and more strongly associated with diastolic pressure after age 45.
由于对于中年及以上人群,收缩压的上升比舒张压更为急剧,导致单纯收缩压升高(即所谓的单纯收缩期高血压)的患病率随年龄增长而增加,而舒张压未升高,因此出现了一个问题,即已被证明与血压和高血压相关的因素是否与单纯收缩期高血压或“经典”高血压(即仅由舒张压水平定义的高血压)相关。在芝加哥的四项流行病学研究中,通过检查几个变量与脉压之间的关联来探讨这个问题,脉压被重新定义,以便变量与脉压之间的关联表明该变量与收缩压还是舒张压的关系更强。在这四项研究中,血糖、心率和吸烟倾向于与收缩压表现出更强的关联,表明可能与单纯收缩期高血压有关,而血细胞比容、血清胆固醇和尿酸倾向于与舒张压的关联更强,或者与收缩压和舒张压的关联相同,表明与“经典”高血压有关。相对体重在35岁以下时倾向于与收缩压的关联更强,而在45岁以后与舒张压的关联更强。