RELATION OF LOW DIASTOLIC BLOOD-PRESSURE TO CORONARY HEART-DISEASE DEATH IN PRESENCE OF MYOCARDIAL-INFARCTION - THE FRAMINGHAM-STUDY
RELATION OF LOW DIASTOLIC BLOOD-PRESSURE TO CORONARY HEART-DISEASE DEATH IN PRESENCE OF MYOCARDIAL-INFARCTION - THE FRAMINGHAM-STUDY
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DOI：
10.1136/bmj.303.6799.385
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发表时间：
1991-08-17
影响因子：
--
通讯作者：
CRUICKSHANK, JM
中科院分区：
文献类型：
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作者：
DAGOSTINO, RB;BELANGER, AJ;CRUICKSHANK, JM
目的-检验血压与冠心病死亡之间的J曲线关系仅限于心肌梗死高危受试者的假设。设计-队列纵向流行病学研究，自1950年以来每两年进行一次检查。美国。受试者- 5209名受试者在FRASTON研究队列中通过个人检查方法进行随访。主要结果测量-冠心病死亡和非冠心病死亡。有或无心肌梗死的男性和女性的心血管疾病死亡与血压的关系结果-在无心肌梗死的受试者中，非心血管疾病死亡是冠心病死亡的两倍至三倍。此外，非心血管疾病死亡与舒张压或收缩压之间没有显著关系。此外，冠心病死亡与舒张压和收缩压呈线性相关。在高风险患者（即心肌梗死但无充血性心力衰竭的人）中，冠心病死亡比非心血管疾病死亡更常见。那里冠心病死亡与舒张压呈显著的U型关系。冠心病死亡与收缩压呈明显的U型关系，但控制年龄和收缩压较梗死前水平的变化后，其关系无统计学意义。当校正了血清胆固醇浓度、抗高血压治疗和左心室功能等危险因素后，上述结论均无改变。舒张压和高风险的主题之间的U形关系存在的两个给予降压治疗和those not.Conclusions -这些数据表明，年龄和性别独立的U曲线关系存在舒张压和冠心病死亡的心肌梗死患者，但不是低风险的主题没有心肌梗死。这种关系似乎与左心室功能和抗高血压治疗无关。
Objective - To examine the hypothesis that a J curve relation between blood pressure and death from coronary heart disease is confined to high risk subjects with myocardial infarction.Design - Cohort longitudinal epidemiological study with biennial examinations since 1950.Setting - Framingham, Massachusetts, USA.Subjects - 5209 subjects in the Framingham study cohort followed up by a person examination approach.Main outcome measures - Coronary heart disease deaths and non-cardiovascular disease deaths in men and women with or without myocardial infarction relative to blood pressure.Results - Among subjects without myocardial infarction non-cardiovascular disease deaths were twice to three times as common as coronary heart disease deaths. Furthermore, there was no significant relation between non-cardiovascular disease death and diastolic or systolic blood pressure. Also coronary heart disease deaths were linearly related to diastolic and systolic blood pressures. Among high risk patients (that is, people with myocardial infarction but free of congestive heart failure) death from coronary heart disease was more common than non-cardiovascular disease death. There. was a significant U shaped relation between coronary heart disease death and diastolic blood pressure. Although there was an apparent U shaped relation between coronary heart disease death and systolic blood pressure, it did not attain statistical significance when controlling for age and change in systolic blood pressure from the pre-myocardial infarction level. None of the above conclusions changed when adjustments were made for risk factors such as serum cholesterol concentration, antihypertensive treatment, and left ventricular function. The U shaped relation between diastolic blood pressure and high risk subjects existed for both those given antihypertensive treatment and those not.Conclusions - These data suggest that an age and sex independent U curve relation exists for diastolic blood pressure and coronary heart disease deaths in patients with myocardial infarction but not for low risk subjects without myocardial infarction. The relation seems to be independent of left ventricular function and antihypertensive treatment.