Effect of Systolic and Diastolic Blood Pressure on Cardiovascular Outcomes
Effect of Systolic and Diastolic Blood Pressure on Cardiovascular Outcomes
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DOI：
10.1056/nejmoa1803180
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发表时间：
2019-07-18
影响因子：
158.5
通讯作者：
Bhatt, Deepak L.
中科院分区：
文献类型：
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作者：
Flint, Alexander C.;Conell, Carol;Bhatt, Deepak L.
背景门诊患者收缩压和舒张压与心血管结局之间的关系尚不清楚，最近修订的治疗高血压的两种不同阈值（>= 140/90 mm Hg和>= 130/80 mm Hg）指南使其复杂化。方法使用来自普通门诊人群的130万成年人的数据，我们进行了多变量考克斯生存分析，以确定8年内收缩期和舒张期高血压负担对心肌梗死、缺血性卒中或出血性卒中复合结局的影响。该分析控制了人口统计学特征和共存条件。结果收缩期和舒张期高血压的负荷分别独立预测不良结局。在生存模型中，收缩期高血压的持续负荷（>= 140 mm Hg; z评分每单位增加的风险比，1.18; 95%置信区间[CI]，1.17 - 1.18）和舒张期高血压（>= 90 mm Hg; z评分每单位增加的风险比为1.06; 95%CI为1.06 ~ 1.07）独立预测复合结局。用低血压阈值（>= 130/80 mm Hg）和收缩压和舒张压作为无高血压阈值的预测因子观察到类似的结果。舒张压和预后之间存在J曲线关系，这至少部分可以用年龄和其他协变量以及舒张压最低四分位数人群中收缩期高血压的影响更大来解释。结论尽管收缩压升高对预后有更大的影响，但无论高血压的定义是什么（>= 140/90 mm Hg或>= 130/80 mm Hg），收缩压和舒张压均独立影响不良心血管事件的风险。（由凯撒永久北方加州社区福利计划资助。）本研究在130万成人门诊患者中确定了收缩期和舒张期高血压对心肌梗死、缺血性卒中或出血性卒中的影响。收缩期血压升高对预后影响更大，但收缩期和舒张期高血压独立影响心血管风险。
Background The relationship between outpatient systolic and diastolic blood pressure and cardiovascular outcomes remains unclear and has been complicated by recently revised guidelines with two different thresholds (>= 140/90 mm Hg and >= 130/80 mm Hg) for treating hypertension. Methods Using data from 1.3 million adults in a general outpatient population, we performed a multivariable Cox survival analysis to determine the effect of the burden of systolic and diastolic hypertension on a composite outcome of myocardial infarction, ischemic stroke, or hemorrhagic stroke over a period of 8 years. The analysis controlled for demographic characteristics and coexisting conditions. Results The burdens of systolic and diastolic hypertension each independently predicted adverse outcomes. In survival models, a continuous burden of systolic hypertension (>= 140 mm Hg; hazard ratio per unit increase in z score, 1.18; 95% confidence interval [CI], 1.17 to 1.18) and diastolic hypertension (>= 90 mm Hg; hazard ratio per unit increase in z score, 1.06; 95% CI, 1.06 to 1.07) independently predicted the composite outcome. Similar results were observed with the lower threshold of hypertension (>= 130/80 mm Hg) and with systolic and diastolic blood pressures used as predictors without hypertension thresholds. A J-curve relation between diastolic blood pressure and outcomes was seen that was explained at least in part by age and other covariates and by a higher effect of systolic hypertension among persons in the lowest quartile of diastolic blood pressure. Conclusions Although systolic blood-pressure elevation had a greater effect on outcomes, both systolic and diastolic hypertension independently influenced the risk of adverse cardiovascular events, regardless of the definition of hypertension (>= 140/90 mm Hg or >= 130/80 mm Hg). (Funded by the Kaiser Permanente Northern California Community Benefit Program.)This study determined the effect of systolic and diastolic hypertension on a composite of myocardial infarction, ischemic stroke, or hemorrhagic stroke in 1.3 million adult outpatients. Systolic blood-pressure elevation affected outcomes more, but systolic and diastolic hypertension independently influenced cardiovascular risk.