Kannel W B, D'Agostino R B, Silbershatz H
Department of Medicine, Evans Memorial Research Foundation, Boston University School of Medicine/Framingham Heart Study, Mass., USA.
Am Heart J. 1997 Oct;134(4):758-63. doi: 10.1016/s0002-8703(97)70061-9.
The influence of blood pressure on the development of cardiovascular disease and mortality rate beyond 75 years of age has been uncertain. A reported inverse relation to mortality rate noted in the very old could reflect poor cardiovascular health. This report examines the impact of blood pressure on cardiovascular morbidity and mortality rates and all-cause mortality rate in those aged 75 to 94 years. For this analysis the data were the Framingham study subjects found free of cardiovascular disease and a second sample of those with cardiovascular disease present on the biennial examinations. Investigation of the relation of systolic and diastolic blood pressures to all causes and cardiovascular morbidity and mortality rates within each 2-year interval for those aged 75 to 94 years was carried out. Over the period of 38 years of follow-up there were increasing cardiovascular morbidity and mortality rates with increasing blood pressure levels for both men and women in the sample free of cardiovascular disease. In those with cardiovascular disease at the biennial examination there was a distinct U-shaped curve of cardiovascular mortality rate in relation to systolic blood pressure in men with a substantial increase in mortality rate below systolic pressures of 120 mm Hg for both men and women. Excess mortality rate reported in elderly persons with low blood pressure appears to be a result of poor cardiovascular health and not from the low pressure itself. The excess mortality rate reported for low blood pressure levels in persons older than 75 years derives from the inclusion of the substantial proportion of this age group who have cardiovascular disease.
血压对75岁以上人群心血管疾病发展及死亡率的影响尚不确定。报告指出，在高龄人群中，血压与死亡率呈负相关，这可能反映出心血管健康状况不佳。本报告探讨了血压对75至94岁人群心血管发病率、死亡率及全因死亡率的影响。该分析的数据来源于弗明汉研究中未患心血管疾病的受试者，以及两年一次体检中患有心血管疾病的另一组样本。研究了75至94岁人群在每2年间隔内收缩压和舒张压与全因、心血管发病率及死亡率之间的关系。在38年的随访期内，未患心血管疾病的样本中，男性和女性的心血管发病率和死亡率均随血压水平升高而增加。在两年一次体检中患有心血管疾病的人群中，男性心血管死亡率与收缩压呈明显的U形曲线，收缩压低于120 mmHg时，男性和女性的死亡率均大幅上升。老年人低血压导致的额外死亡率似乎是心血管健康状况不佳的结果，而非低血压本身所致。75岁以上人群中因低血压水平报告的额外死亡率源于该年龄组中相当一部分患有心血管疾病。
