老年受试者的低舒张压与动脉粥样硬化。鹿特丹研究。

Low diastolic blood pressure and atherosclerosis in elderly subjects. The Rotterdam study.

作者信息

Bots M L, Witteman J C, Hofman A, de Jong P T, Grobbee D E

机构信息

Department of Epidemiology & Biostatistics, Erasmus University Medical School, Rotterdam, the Netherlands.

出版信息

Arch Intern Med. 1996 Apr 22;156(8):843-8.

PMID:8774202

Abstract

BACKGROUND

A low diastolic blood pressure has been associated with increased cardiovascular risk. The following proposed mechanisms underlie this phenomenon: a low diastolic pressure that compromises coronary blood flow, a low diastolic pressure that is due to deteriorating health, and a low diastolic pressure that is a consequence of stiffening of the large arteries. Atherosclerosis may be the link between stiffening of the arteries, a low diastolic pressure, and an increased cardiovascular risk.

OBJECTIVE

To study whether a low diastolic blood pressure in older subjects is a reflection of atherosclerosis.

METHODS

The Rotterdam (the Netherlands) Study is a population-based follow-up study of 7983 subjects (age, > or = 55 years) who are living in the suburb of Ommoord of Rotterdam. Baseline measurements included ultrasonographic evaluation of the carotid arteries, measurement of blood pressure, and determination of other cardiovascular risk factors. The main cross-sectional analyses were performed among 930 subjects who currently were not using blood pressure-lowering drugs.

RESULTS

A J-shaped association of the intima-media thickness of the common carotid artery with diastolic blood pressure was found with a nadir from 60 to 69 mm Hg. The intima-media thickness was increased in subjects with a diastolic pressure that was less than 60 mm Hg compared with that in subjects with a diastolic pressure that was between 60 and 69 mm Hg (a difference of 0.033 mm [95% confidence limits; 0.001, 0.065]). Beyond a diastolic pressure of 70 mm Hg, a gradual increase in the intima-media thickness was observed. The association was most pronounced among subjects with relatively high pulse pressures.

CONCLUSIONS

Results of the present study indicate the existence of a J-shaped association between carotid atherosclerosis and diastolic pressure. These findings support the hypothesis that in elderly subjects, a low diastolic pressure may be a reflection of widespread atherosclerosis.

摘要

背景

舒张压降低与心血管风险增加有关。以下几种机制可解释这一现象：舒张压降低会影响冠状动脉血流；健康状况恶化导致舒张压降低；大动脉僵硬度增加致使舒张压降低。动脉粥样硬化可能是动脉僵硬度增加、舒张压降低与心血管风险增加之间的联系。

目的

研究老年受试者舒张压降低是否是动脉粥样硬化的一种表现。

方法

鹿特丹（荷兰）研究是一项基于人群的随访研究，对象为居住在鹿特丹Ommoord郊区的7983名年龄≥55岁的受试者。基线测量包括颈动脉超声评估、血压测量以及其他心血管危险因素的测定。主要横断面分析在930名目前未使用降压药物的受试者中进行。

结果

发现颈总动脉内膜中层厚度与舒张压呈J形关联，最低点在60至69mmHg之间。舒张压低于60mmHg的受试者的内膜中层厚度高于舒张压在60至69mmHg之间的受试者（差值为0.033mm[95%置信区间：0.001，0.065]）。舒张压超过70mmHg后，内膜中层厚度逐渐增加。这种关联在脉压相对较高的受试者中最为明显。