Association between blood pressure level and the risk of myocardial infarction, stroke, and total mortality -: The cardiovascular health study
Association between blood pressure level and the risk of myocardial infarction, stroke, and total mortality -: The cardiovascular health study
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DOI：
10.1001/archinte.161.9.1183
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发表时间：
2001-05-14
影响因子：
--
通讯作者：
Lumley, T
中科院分区：
文献类型：
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作者：
Psaty, BM;Furberg, CD;Lumley, T
背景：最近的报道已经引起了人们对脉压作为心血管事件预测因子的重要性的关注。脉压既不是由临床医生也不是由指南来定义可治疗的血压水平。方法：在心血管健康研究，5888名65岁及以上的成年人从4个美国中心招募。在基线在1989-1990年，参与者进行了广泛的检查，所有随后的心血管事件进行了确定和classificed.Results：在基线，1961名男性和2941名女性有发生心肌梗死或中风的风险。在平均6.7年的随访期间，572名受试者发生了冠状动脉事件，385名中风，896名死亡。校正潜在混杂因素后，收缩压（SBP）、舒张压（DBP）和脉压与心肌梗死和卒中的发生风险直接相关。只有SEP与总死亡率相关。重要的是，SEP是比DBP或脉压更好的心血管事件预测因子。在校正的心肌梗死模型中，SEP、DBP和脉压的1-SD变化分别与1.24（1.15-1.35）、1.13（1.04-1.22）和1.21（1.12-1.31）的风险比（95%置信区间）相关;将脉压或DBP添加到模型中并没有改善拟合。对于卒中，SEP、DBP和脉压的风险比（95%置信区间）分别为1.34（1.21-1.47）、1.29（1.17-1.42）和1.21（1.10-1.34）。血压水平和心血管疾病风险之间的关系通常是线性的;具体来说，没有证据表明存在J形关系。在那些治疗高血压，SEP与心肌梗死和中风的风险的关联的风险比不太明显，比那些没有治疗高血压。结论：在这项以人群为基础的研究，老年人，虽然所有措施的血压是强烈的。SEP与冠状动脉和脑血管事件的风险直接相关，是心血管事件的最佳单一预测因子。
Background: Recent reports have drawn attention to the importance of pulse pressure as a predictor of cardiovascular events. Pulse pressure is used neither by clinicians nor by guidelines to define treatable levels of blood pressure.Methods: In the Cardiovascular Health Study, 5888 adults 65 years and older were recruited from 4 US centers. At baseline in 1989-1990, participants underwent an extensive examination, and all subsequent cardiovascular events were ascertained and classified.Results: At baseline, 1961 men and 2941 women were at risk for an incident myocardial infarction or stroke. During follow-up that averaged 6.7 years, 572 subjects had a coronary event, 385 had a stroke, and 896 died. After adjustment for potential confounders, systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure were directly associated with the risk of incident myocardial infarction and stroke. Only SEP was associated with total mortality. Importantly, SEP was a better predictor of cardiovascular events than DBP or pulse pressure. In the adjusted model for myocardial infarction, a 1-SD change in SEP, DBP, and pulse pressure was associated with hazard ratios (95% confidence intervals) of 1.24 (1.15-1.35), 1.13 (1.04-1.22), and 1.21 (1.12-1.31), respectively; and adding pulse pressure or DBP to the model did not improve the fit. For stroke, the hazard ratios (95% confidence intervals) were 1.34 (1.21-1.47) with SEP, 1.29 (1.17-1.42) with DBP, and 1.21 (1.10-1.34) with pulse pressure. The association between blood pressure level and cardiovascular disease risk was generally linear; specifically, there was no evidence of a J-shaped relationship. In those with treated hypertension, the hazard ratios for the association of SEP with the risks for myocardial infarction and stroke were less pronounced than in those without treated hypertension.Conclusion: In this population-based study of older adults, although all measures of blood pressure were strongly and. directly related to the risk of coronary and cerebrovascular events, SEP was the best single predictor of cardiovascular events.