Isolated Diastolic Hypertension and Risk of Cardiovascular Events: A Systematic Review and Meta-Analysis of Cohort Studies With 489,814 Participants.
Isolated Diastolic Hypertension and Risk of Cardiovascular Events: A Systematic Review and Meta-Analysis of Cohort Studies With 489,814 Participants.
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DOI：
10.3389/fcvm.2021.810105
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发表时间：
2021
影响因子：
3.6
通讯作者：
Chen K
中科院分区：
文献类型：
--
作者：
Huang M;Long L;Tan L;Shen A;Deng M;Peng Y;Yang W;Li H;Wei Y;Li M;Liao F;Liu C;Lu A;Qu H;Fu C;Chen K
背景：孤立性舒张期高血压（IDH）与心血管事件之间的相关性报道不一致。这项队列研究的荟萃分析旨在研究2018年欧洲心脏病学会（ESC）IDH定义对复合心血管事件、心血管死亡率、全因死亡率和所有卒中（包括缺血性卒中（IS）和出血性卒中（HS））风险的影响。方法：检索PubMed、Embase、科克伦图书馆和Web of Science，检索时间从开始到2021年7月6日。纳入了研究IDH与心血管事件风险之间相关性的队列研究，与血压正常者相比。使用随机效应模型计算合并风险比（HR）和95% CI，并使用Q检验和I2统计量评价异质性。使用敏感性分析确定了相关性的稳健性。使用Newcastle-Ottawa量表评估研究的方法学质量。发表偏倚采用漏斗图、修剪填充法、Begg检验和Egger检验进行评估。结果：本荟萃分析共纳入15项队列研究（13篇文章），包括489，814例受试者。随访时间为4.3 ~ 29年。IDH与复合心血管事件的风险增加显著相关（HR 1.28，95% CI：1.07-1.52，p = 0.006），心血管死亡率（HR 1.45，95% CI：1.07-1.95，p = 0.015），所有卒中（HR 1.44，95% CI：1.04-2.01，p = 0.03）和HS（HR 1.64，95% CI：1.18-2.29，p = 0.164），但与全因死亡率无关（HR 1.20，95% CI：0.97-1.47，p = 0.087）和IS（HR 1.56，95% CI：0.87-2.81，p = 0.137）。亚组分析进一步表明，年轻患者（平均年龄≤ 55岁）和来自亚洲的IDH与复合心血管事件风险增加显著相关，而老年患者（平均年龄≥ 55岁）、美国人和欧洲人与复合心血管事件风险增加无显著相关性。结论：这项荟萃分析提供的证据表明，使用2018年ESC标准定义的IDH与复合心血管事件、心血管死亡率、所有卒中和HS的风险增加显著相关，但与全因死亡和IS无显著相关性。这些发现也强调了IDH患者血压在正常范围内的重要性，特别是年轻人和亚洲人。试验注册：PROSPERO，标识符：CRD 42021254108。
Background: The association between isolated diastolic hypertension (IDH) and cardiovascular events has been inconsistently reported. This meta-analysis of cohort studies was designed to investigate the effect of the 2018 European Society of Cardiology (ESC) definition of IDH on the risk of composite cardiovascular events, cardiovascular mortality, all-cause mortality, and all strokes including ischemic stroke (IS) and hemorrhagic stroke (HS). Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to July 6, 2021. Cohort studies that investigated the association between IDH and cardiovascular events risk, compared to normotension, were included. Pooled hazard ratios (HRs) and 95% CIs were calculated using a random-effects models and heterogeneity was evaluated using Q-test and I2 statistic. The robustness of the associations was identified using sensitivity analysis. The methodological quality of the studies was assessed using the Newcastle–Ottawa scale. Publication bias was assessed using funnel plot, trim-and-fill method, Begg's test, and Egger's test. Results: A total of 15 cohort studies (13 articles) including 489,814 participants were included in this meta-analysis. The follow-up period ranged from 4.3 to 29 years. IDH was significantly associated with an increased risk of composite cardiovascular events (HR 1.28, 95% CI: 1.07–1.52, p = 0.006), cardiovascular mortality (HR 1.45, 95% CI: 1.07–1.95, p = 0.015), all strokes (HR 1.44, 95% CI: 1.04–2.01, p = 0.03), and HS (HR 1.64, 95% CI: 1.18–2.29, p = 0.164), but not associated with all-cause mortality (HR 1.20, 95% CI: 0.97–1.47, p = 0.087) and IS (HR 1.56, 95% CI: 0.87–2.81, p = 0.137). Subgroup analysis further indicated that IDH in the younger patients (mean age ≤ 55 years) and from Asia were significantly associated with an increased risk of composite cardiovascular events, while the elderly patients (mean age ≥ 55 years), Americans, and Europeans were not significantly associated with an increased risk of composite cardiovascular events. Conclusion: This meta-analysis provides evidence that IDH defined using the 2018 ESC criterion is significantly associated with an increased risk of composite cardiovascular events, cardiovascular mortality, all strokes and HS, but not significantly associated with all-cause death and IS. These findings also emphasize the importance for patients with IDH to have their blood pressure within normal, especially in the young adults and Asians. Trial Registration: PROSPERO, Identifier: CRD42021254108.