Usefulness of hypertensive blood pressure response during a single-stage exercise test to predict long-term outcome in patients with peripheral arterial disease
Usefulness of hypertensive blood pressure response during a single-stage exercise test to predict long-term outcome in patients with peripheral arterial disease
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DOI：
10.1016/j.amjcard.2008.05.032
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发表时间：
2008-10-01
影响因子：
2.8
通讯作者：
Poldermans, Don
中科院分区：
文献类型：
--
作者：
de Liefde, Inge I.;Hoeks, Sanne E.;Poldermans, Don
高血压(BP)反应的预后价值仍不清楚。因此，研究了外周动脉疾病(PAD)患者在单次运动试验期间的高血压血压反应对长期死亡率和主要不良脑血管和心脏事件(MACCEs)的预后价值。此外，还研究了他汀类药物、β-受体阻滞剂和阿司匹林在已知或可疑PAD患者中的作用。从1993年到2005年，共有2109名患者参加了一项观察性前瞻性研究。高血压血压反应被定义为在单级跑步机运动试验后收缩压升高=55毫米汞柱(我们人群中的第95个百分位数)。通过使用民事登记获得结果，并向所有幸存者发送关于心脏事件的调查问卷。高血压血压反应与长期死亡率(危险比[HR]1.42，95%可信区间[CI]1.12至1.80)和MACCEs(危险比1.47，95%可信区间1.09至1.97)增加相关。在调整了临床危险因素和倾向评分后，他汀类药物的基线使用与长期死亡率的风险降低相关(HR 0.59，95%CI 0.44至0.79)，他汀类药物、β-受体阻滞剂和阿司匹林的使用与MACCEs的风险降低相关(HR 0.59，95%CI 0.43至0.81；HR 0.75，95%CI 0.60至0.95；HR 0.73，95%CI，0.57至0.92)。总之，已知或怀疑患有PAD的患者运动时的高血压反应是全因长期死亡率和MACCEs的重要独立危险因素，而他汀类药物、β-受体阻滞剂和阿司匹林的使用与改善预后相关。(C)2008 Elsevier Inc.保留所有权利。
The prognostic value of a hypertensive blood pressure (BP) response is still unclear. Therefore, the prognostic value of a hypertensive BP response in patients during single-stage exercise testing for peripheral arterial disease (PAD) on long-term mortality and major adverse cerebrovascular and cardiac events (MACCEs) was investigated. In addition, effects of statin, beta-blocker, and aspirin use in patients with known or suspected PAD were studied. A total of 2,109 patients were enrolled in an observational prospective study from 1993 to 2005. Hypertensive BP response was defined as an increase in systolic BP >= 55 mm Hg (95(th) percentile within our population) after a single-stage treadmill exercise test. The outcome was obtained by using the civil registries, and a questionnaire about cardiac events was sent to all survivals. Hypertensive BP response was associated with increased risk of long-term mortality (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.12 to 1.80) and MACCEs (HR 1.47, 95% CI 1.09 to 1.97). After adjustments for clinical risk factors and propensity score, baseline statin use was associated with reduced risk of long-term mortality (HR 0.59, 95% CI 0.44 to 0.79), and statin, beta-blocker, and aspirin use were associated with reduced risk of MACCEs (HR 0.59,95% CI 0.43 to 0.81; HR 0.75, 95% CI 0.60 to 0.95; HR 0.73, 95% CI, 0.57 to 0.92, respectively). In conclusion, hypertensive BP response at exercise in patients with known or suspected PAD is an important independent risk factor for all-cause long-term mortality and MACCEs, whereas statin, beta-blocker, and aspirin use were associated with an improved outcome. (C) 2008 Elsevier Inc. All rights reserved.