Tervahauta M, Pekkanen J, Enlund H, Nissinen A
Department of Community Health and General Practice, University of Kuopio, Finland.
J Hypertens. 1994 Oct;12(10):1183-9.
To study the association between blood pressure and change in blood pressure with future coronary risk among elderly men.
Cohort study.
Finnish cohorts of the Seven Countries Study.
Four hundred and seventy-six men aged 65-84 years and free of clinically manifested coronary heart disease at baseline, in 1984.
Fatal myocardial infarction (n = 29), any myocardial infarction (n = 42), and incidence of any new signs and symptoms of coronary heart disease (n = 80) during a 5-year follow-up.
In multivariate analysis, a significant inverse U-shaped relationship was observed between baseline diastolic blood pressure and future fatal myocardial infarction, any myocardial infarction and any coronary heart disease. In models predicting the risk of coronary heart disease during 1984-1989, there was a significant interaction between both systolic (SBP) and diastolic blood pressure (DBP) in 1969-1974 and change in blood pressure between 1969-1974 and 1984. In categorical analyses, men (n = 42) who experienced a decline in DBP of > or = 4 mmHg from initial levels of > or = 90 mmHg had a higher risk of any myocardial infarction than men (n = 112) with a change of < 4 mmHg (odds ratio 4.5). For a decline of > or = 10 mmHg or more in SBP from levels of > or = 160 mmHg the corresponding odds ratio was 2.9. Men who experienced a decline in DBP or SBP from normotensive levels or an increase in blood pressure had no excess risk compared with men with stabile (change in DBP < 4 mmHg and change in SBP < 10 mmHg) blood pressure values.
The present results suggest that among elderly men a decline in DBP or SBP from previously hypertensive levels may be associated with increased coronary risk.
研究老年男性血压及血压变化与未来冠心病风险之间的关联。
队列研究。
七国研究中的芬兰队列。
1984年基线时476名年龄在65 - 84岁且无临床表现冠心病的男性。
5年随访期间的致命性心肌梗死（n = 29）、任何心肌梗死（n = 42）以及冠心病任何新体征和症状的发生率（n = 80）。
在多变量分析中，观察到基线舒张压与未来致命性心肌梗死、任何心肌梗死及任何冠心病之间存在显著的倒U形关系。在预测1984 - 1989年冠心病风险的模型中，1969 - 1974年的收缩压（SBP）和舒张压（DBP）以及1969 - 1974年与1984年之间的血压变化存在显著交互作用。在分类分析中，舒张压从初始水平≥90 mmHg下降≥4 mmHg的男性（n = 42）发生任何心肌梗死的风险高于舒张压变化<4 mmHg的男性（n = 112）（比值比4.5）。收缩压从≥160 mmHg水平下降≥10 mmHg或更多时，相应比值比为2.9。与血压稳定（舒张压变化<4 mmHg且收缩压变化<10 mmHg）的男性相比，舒张压或收缩压从正常血压水平下降或血压升高的男性没有额外风险。
目前的结果表明，在老年男性中，舒张压或收缩压从先前的高血压水平下降可能与冠心病风险增加有关。
