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收缩压和舒张压对心血管结局的影响
Effect of Systolic and Diastolic Blood Pressure on Cardiovascular Outcomes


Alexander C. Flint ... 心脑血管疾病 • 2019.07.18
相关阅读
• 收缩压和舒张压与心血管结局之间的关联 • 强化降压与标准降压比较的随机试验 • 强化降压治疗对患者报告结局的影响

摘要


背景

门诊患者收缩压和舒张压与心血管结局之间的关系仍未明确,而最近做出修订,为高血压治疗设定两个不同阈值(≥140/90 mmHg和≥130/80 mmHg)的指南使这一关系变得复杂。

 

方法

我们利用130万普通门诊成人患者的数据开展了一项多变量Cox生存分析,旨在确定收缩期和舒张期高血压负荷在8年期间对复合结局(心肌梗死、缺血性卒中或出血性卒中)产生的影响。我们针对人口统计学特征和合并症对本分析进行了控制。

 

结果

收缩期和舒张期高血压负荷分别独立预测了不良结局。在生存模型中,收缩期高血压(≥140 mmHg;z评分每单位增幅的风险比,1.18;95%置信区间[CI],1.17~1.18)和舒张期高血压(≥90 mmHg;z评分每单位增幅的风险比,1.06;95% CI,1.06~1.07)的持续负荷独立预测了复合结局。使用较低的高血压阈值(≥130/80 mmHg)以及使用收缩压和舒张压用作预测因素(未设定高血压阈值)时,我们观察到类似结果。我们在舒张压和结局之间观察到J形曲线关系,而以下因素至少提供了部分解释:年龄和其他协变量,以及收缩期高血压在位于舒张压最低四分位的人群中产生了较大影响。

 

结论

虽然收缩压升高对结局的影响较大,但收缩期和舒张期高血压均独立影响了心血管不良事件风险,不论采用哪个阈值(≥140/90 mmHg或≥130/80 mmHg)定义高血压,结果均如此(由凯泽永久医疗集团[Kaiser Permanente]北加利福尼亚社区福利计划[Northern California Community Benefit Program]资助)。





作者信息

Alexander C. Flint, M.D., Ph.D., Carol Conell, Ph.D., Xiushui Ren, M.D., Nader M. Banki, M.D., Sheila L. Chan, M.D., Vivek A. Rao, M.D., Ronald B. Melles, M.D., and Deepak L. Bhatt, M.D., M.P.H.
From the Division of Research, Kaiser Permanente Northern California, Oakland (A.C.F., C.C.), and the Departments of Neuroscience (A.C.F., S.L.C., V.A.R., R.B.M.) and Cardiology (X.R., N.M.B.), Kaiser Permanente, Redwood City — both in California; and Brigham and Women’s Hospital Heart and Vascular Center and Harvard Medical School — both in Boston (D.L.B.). Address reprint requests to Dr. Flint at the Division of Research and Department of Neuroscience, Kaiser Permanente, 1150 Veterans Blvd., Redwood City, CA 94063, or at alexander.c.flint@kp.org.

 

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