Cardiovascular End Points and Mortality Are Not Closer Associated With Central Than Peripheral Pulsatile Blood Pressure Components
Cardiovascular End Points and Mortality Are Not Closer Associated With Central Than Peripheral Pulsatile Blood Pressure Components
复制标题
心血管终点和死亡率与中枢脉动血压成分的相关性并不比外周脉动血压成分更密切
DOI：
10.1161/hypertensionaha.120.14787
复制
发表时间：
2020-08-01
期刊：
影响因子：
8.3
通讯作者：
Staessen, Jan A.
中科院分区：
文献类型：
--
作者：
Huang, Qi-Fang;Aparicio, Lucas S.;Staessen, Jan A.
补充数字内容可在文本中找到。脉动血压（BP）赋予心血管风险。中心收缩压（cSBP）与外周收缩压（pSBP）或中心脉压（cPP）与外周脉压（pPP）的心血管终点相关性是否更紧密尚不确定。在9项研究的5608名参与者（54.1%为女性;平均年龄54.2岁）中，中位随访时间为4.1年。根据径向波形通过眼压计估计的cSBP和cPP平均为123.7和42.5 mm Hg，pSBP和pPP平均为134.1和53.9 mm Hg。主要复合心血管终点发生在255名参与者（4.5%）中。在cPP分布的四分之一中，发生率呈指数级增加（4.1、5.0、7.3和22.0/1000人-年），cSBP、pSBP和pPP的估计值相当。多变量校正的风险比，表示血压每增加1-SD的风险，为1.50 cSBP、cPP、pSBP和pPP的平均值分别为1.36（95%CI，1.19-1.54）、1.49（95%CI，1.33-1.67）和1.34（95%CI，1.19-1.51）（P<0.001）。分别针对pSBP和pPP进一步调整cSBP和cPP，反之亦然，消除了所有风险比的显著性。将cSBP、cPP、pSBP、pPP添加到包括协变量的基础模型中增加了模型拟合（P<0.001），广义R2增量范围为0.37%至0.74%，但将第二个BP添加到包括一个BP的模型中则没有。对次要终点的分析，包括总死亡率（204例死亡）、冠状动脉终点（109例）和卒中（89例），以及各种敏感性分析产生了一致的结果。总之，与外周血压相比，如果血压在中心测量，主要和次要终点与SBP和脉压的相关性并不强。
Supplemental Digital Content is available in the text. Pulsatile blood pressure (BP) confers cardiovascular risk. Whether associations of cardiovascular end points are tighter for central systolic BP (cSBP) than peripheral systolic BP (pSBP) or central pulse pressure (cPP) than peripheral pulse pressure (pPP) is uncertain. Among 5608 participants (54.1% women; mean age, 54.2 years) enrolled in nine studies, median follow-up was 4.1 years. cSBP and cPP, estimated tonometrically from the radial waveform, averaged 123.7 and 42.5 mm Hg, and pSBP and pPP 134.1 and 53.9 mm Hg. The primary composite cardiovascular end point occurred in 255 participants (4.5%). Across fourths of the cPP distribution, rates increased exponentially (4.1, 5.0, 7.3, and 22.0 per 1000 person-years) with comparable estimates for cSBP, pSBP, and pPP. The multivariable-adjusted hazard ratios, expressing the risk per 1-SD increment in BP, were 1.50 (95% CI, 1.33–1.70) for cSBP, 1.36 (95% CI, 1.19–1.54) for cPP, 1.49 (95% CI, 1.33–1.67) for pSBP, and 1.34 (95% CI, 1.19–1.51) for pPP (P<0.001). Further adjustment of cSBP and cPP, respectively, for pSBP and pPP, and vice versa, removed the significance of all hazard ratios. Adding cSBP, cPP, pSBP, pPP to a base model including covariables increased the model fit (P<0.001) with generalized R2 increments ranging from 0.37% to 0.74% but adding a second BP to a model including already one did not. Analyses of the secondary end points, including total mortality (204 deaths), coronary end points (109) and strokes (89), and various sensitivity analyses produced consistent results. In conclusion, associations of the primary and secondary end points with SBP and pulse pressure were not stronger if BP was measured centrally compared with peripherally.