Diastolic blood pressure and mortality in the elderly with cardiovascular disease
Diastolic blood pressure and mortality in the elderly with cardiovascular disease
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DOI：
10.1161/hypertensionaha.107.089797
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发表时间：
2007-07-01
期刊：
影响因子：
8.3
通讯作者：
Blacher, Jacques
中科院分区：
文献类型：
--
作者：
Protogerou, Athanase D.;Safar, Michel E.;Blacher, Jacques
单纯的收缩期高血压主要见于老年人，因为动脉僵硬增加。积极的治疗会导致舒张压的过度降低，并倾向于出现与死亡率相关的J形曲线。我们调查了在老年人中，这种关联模式是否是动脉僵硬增加和心脏功能受损的简单附带现象。在331名住院受试者中，70岁(平均年龄+/-SD：85+/-7岁)，用脉搏波分析评估了主动脉脉搏波速度和压力波反射，用超声评估了心功能。在两年的随访期内，110名受试者死亡。未观察到预后与收缩压、脉压或脉搏波速度有关。观察到舒张压与总死亡率和心血管死亡率之间呈J型关系。非校正COX回归分析显示，患者在舒张压的前三分位数(
Isolated systolic hypertension is predominantly observed in the elderly because of increased arterial stiffness. Aggressive treatment leads to excessive lowering of diastolic blood pressure and favors the presence of a J-shaped curve association with mortality. We investigated whether, in the elderly, this pattern of association is a simple epiphenomenon of increased arterial stiffness and impaired cardiac function. In a cohort of 331 hospitalized subjects > 70 years old (mean age +/- SD: 85 +/- 7 years), aortic pulse wave velocity and pressure wave reflections, by pulse wave analysis, and cardiac function, by ultrasound, were assessed. During a 2-year follow-up period, 110 subjects died. No association of prognosis with systolic pressure, pulse pressure, or pulse wave velocity was observed. A J-shaped association between diastolic pressure and overall and cardiovascular mortality was observed. Unadjusted Cox regression analysis showed that patients in the first tertile of diastolic pressure (