Gillman M W, Kannel W B, Belanger A, D'Agostino R B
Evans Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, MA 02118.
Am Heart J. 1993 Apr;125(4):1148-54. doi: 10.1016/0002-8703(93)90128-v.
Previous studies have shown positive associations between heart rate and both all-cause and cardiovascular mortality. These relationships, however, have not been investigated in persons with hypertension. Using 36-year follow-up data from the Framingham Study, we evaluated from 4530 subjects, aged 35 to 74, whose blood pressures were > or = 140 mm Hg systolic or > or = 90 mm Hg diastolic and who were not treated with antihypertensive medication. We used pooled logistic regression to calculate biennial mortality rates. Odds ratios and 95% confidence intervals for each increment in heart rate of 40 beats/min, adjusted for age and systolic blood pressure level, were: for all-cause mortality, 2.18 (1.68, 2.83) for men and 2.14 (1.59, 2.88) for women; and for cardiovascular mortality, 1.68 (1.19, 2.37) for men and 1.70 (1.08, 2.67) for women. Exclusion of outcomes in the first 2 or 4 years after measurement of heart rate did not materially change the results, which suggests that rapid heart is not merely an indicator of preexisting illness. Therefore heart rate may be an independent risk factor for cardiovascular death in persons with hypertension.
以往的研究表明，心率与全因死亡率和心血管死亡率之间存在正相关关系。然而，这些关系尚未在高血压患者中进行研究。利用弗明汉姆研究的36年随访数据，我们对4530名年龄在35至74岁之间、收缩压≥140毫米汞柱或舒张压≥90毫米汞柱且未接受抗高血压药物治疗的受试者进行了评估。我们使用汇总逻辑回归来计算两年期死亡率。在调整年龄和收缩压水平后，心率每增加40次/分钟的比值比和95%置信区间为：全因死亡率方面，男性为2.18（1.68，2.83），女性为2.14（1.59，2.88）；心血管死亡率方面，男性为1.68（1.19，2.37），女性为1.70（1.08，2.67）。排除心率测量后前2年或4年的结果并未实质性改变结果，这表明心率加快不仅仅是既往疾病的一个指标。因此，心率可能是高血压患者心血管死亡的一个独立危险因素。
