Isolated diastolic hypotension and incident heart failure in older adults.
Isolated diastolic hypotension and incident heart failure in older adults.
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DOI：
10.1161/hypertensionaha.111.178178
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发表时间：
2011-11
期刊：
影响因子：
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通讯作者：
Ahmed A
中科院分区：
文献类型：
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作者：
Guichard JL;Desai RV;Ahmed MI;Mujib M;Fonarow GC;Feller MA;Ekundayo OJ;Bittner V;Aban IB;White M;Aronow WS;Love TE;Bakris GL;Zieman SJ;Ahmed A
衰老通常与收缩压升高和舒张压降低有关。单纯性收缩期高血压或收缩期血压升高而无舒张期血压升高是老年人发生心力衰竭的已知危险因素。在本研究中，我们检查了单纯舒张期低血压（定义为舒张压<60 mm Hg且收缩压≥100 mm Hg）是否与心力衰竭事件相关。在心血管健康研究中，5795名年龄≥65岁的符合Medicare资格的社区居住成人中，5521名在基线时未发生心力衰竭。在排除了145名基线收缩压<100 mm Hg的个体后，最终样本包括5376名参与者，其中751名（14%）患有孤立性舒张期低血压。计算了5376名参与者的孤立性舒张期低血压倾向评分，并分别用于匹配545名和2348名有和无孤立性舒张期低血压的参与者，这些参与者在58个基线特征上保持平衡。在超过12年的中位随访期间，中心裁定的事件心力衰竭分别发生在25%和20%的有和无孤立性舒张期低血压的匹配参与者中（与孤立性舒张期低血压相关的风险比，1.33; 95%置信区间，1.10-1.61; p=0.004）。在5376例匹配前个体中，与单纯舒张期低血压相关的心力衰竭事件的多变量校正风险比为1.29（95%置信区间，1.09-1.53; p=0.003）。与单纯收缩期高血压一样，在社区居住的无心力衰竭的老年人中，单纯舒张期低血压也是心力衰竭事件的重要独立危险因素。
Aging is often associated with increased systolic blood pressure and decreased diastolic blood pressure. Isolated systolic hypertension or an elevated systolic blood pressure without an elevated diastolic blood pressure is a known risk factor for incident heart failure in older adults. In the current study, we examined whether isolated diastolic hypotension, defined as a diastolic blood pressure <60 mm Hg and a systolic blood pressure ≥100 mm Hg, is associated with incident heart failure. Of the 5795 Medicare-eligible community-dwelling adults age ≥65 years in the Cardiovascular Health Study, 5521 were free of prevalent heart failure at baseline. After excluding 145 individuals with baseline systolic blood pressure <100 mm Hg, the final sample included 5376 participants, of whom 751 (14%) had isolated diastolic hypotension. Propensity scores for isolated diastolic hypotension were calculated for each of the 5376 participants and used to match 545 and 2348 participants with and without isolated diastolic hypotension, respectively who were balanced on 58 baseline characteristics. During over 12 years of median follow-up, centrally-adjudicated incident heart failure developed in 25% and 20% of matched participants with and without isolated diastolic hypotension respectively (hazard ratio associated with isolated diastolic hypotension, 1.33; 95% confidence interval, 1.10–1.61; p=0.004). Among the 5376 pre-match individuals, multivariable-adjusted hazard ratio for incident heart failure associated with isolated diastolic hypotension was 1.29 (95% confidence interval, 1.09–1.53; p=0.003). As in isolated systolic hypertension, among community-dwelling older adults without prevalent heart failure, isolated diastolic hypotension is also a significant independent risk factor for incident heart failure.