Association of blood pressure indices and stroke mortality in isolated systolic hypertension.
Association of blood pressure indices and stroke mortality in isolated systolic hypertension.
复制标题
单纯收缩期高血压的血压指数与卒中死亡率的关联。
DOI：
10.1161/01.str.0000166201.79222.4d
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发表时间：
2005
期刊：
影响因子：
8.3
通讯作者：
Mosca,Lori
中科院分区：
文献类型：
--
作者：
Paultre,Furcy;Mosca,Lori
背景和目的：单纯收缩期高血压（ISH），即收缩压（BP）≥160 mm Hg，舒张压（DBP）<90 mm Hg，与脑卒中相关;然而，ISH中特定BP指数和中风死亡率之间的相关性尚未确定。方法-在9项流行病学研究的汇总分析中，我们研究了在ISH患者中，脉压（PP）是否比收缩压（SBP）、舒张压（DBP）或平均血压（MAP）更能预测卒中死亡率。受试者（n=682; 29%为男性;白色占77%;平均年龄63.6岁，无心血管疾病，基线时未接受抗高血压药物治疗，平均随访13.0±7.3年，发生54例卒中死亡。由于在考克斯回归模型中增加了1个或多个BP指数的组合，通过-2对数似然（模型与数据一致性的度量）的降低来比较每个BP指数的相对重要性。结果-根据-2对数似然的降低，PP是卒中死亡率的最佳预测因子（10.65;P=0.001; HR=1.52），其次是SBP（7.19;P=0.007; HR=1.40）、DBP（2.76;P=0.10; HR=0.80）或MAP（0.39;P=0.39; HR=1.10）。任何血压指数的组合都没有超过-2对数似然的下降10.72。结论-这些数据表明，在ISH患者中，PP是比SBP、DBP或MAP更好的致死性卒中预测因子。
Background and Purpose—Isolated systolic hypertension (ISH), systolic blood pressure (BP) ≥160 mm Hg and diastolic BP (DBP) <90 mm Hg, is associated with stroke; however, the correlation between specific BP indices and stroke mortality in ISH is not defined.Methods—In a pooled analysis of 9 epidemiological studies, we examined whether pulse pressure (PP) was more predictive of stroke mortality than systolic BP (SBP), DBP, or mean BP (MAP) in persons with ISH. Subjects (n=682; 29% male; 77% white; mean age 63.6 years) with ISH, free of cardiovascular disease, and not on antihypertensive drug therapy at baseline were followed a mean of 13.0±7.3 years, and 54 stroke deaths occurred. The relative importance of each BP index was compared by the decrease in the −2 log likelihood (a measure of model agreement with data) because of the addition of 1 or a combination of BP indices to a Cox regression model. Hazards ratios (HRs) for fatal stroke for a 1-SD in BP index were determined.Results—PP was the best predictor of stroke mortality based on the decrease in the −2 log likelihood (10.65;P=0.001; HR=1.52), followed by SBP (7.19;P=0.007; HR=1.40), DBP (2.76;P=0.10; HR=0.80), or MAP (0.39;P=0.39; HR=1.10). Any combination of BP indices did not exceed a decrease in the −2 log likelihood of 10.72.Conclusion—These data suggest that in persons with ISH, PP is a better predictor of fatal stroke than SBP, DBP, or MAP.