Time spent at blood pressure target and the risk of death and cardiovascular diseases.
Time spent at blood pressure target and the risk of death and cardiovascular diseases.
复制标题
DOI：
10.1371/journal.pone.0202359
复制
发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Hemingway H
中科院分区：
文献类型：
--
作者：
Chung SC;Pujades-Rodriguez M;Duyx B;Denaxas SC;Pasea L;Hingorani A;Timmis A;Williams B;Hemingway H
患者将血压保持在目标水平的时间是成功血压管理的直观衡量标准，但关于其有效性的人群研究迄今尚不存在。我们确定了一个基于人群的队列，该队列包括169,082名新发现的高血压患者，他们在1997年1月至2010年3月期间没有心血管疾病。我们使用了164万个临床血压读数，根据当前的目标血压水平计算达到目标的时间(滴度)。所有患者的中位滴度(四分位数范围)为每年2.8(0.3，5.6)个月，仅有10 77例(0.6%)患者的≥为11个月。与滴度为0%的人相比，滴度为3-5.9个月和6-8.9个月的患者心血管死亡、心肌梗死和中风的综合风险分别降低75%和78%(调整后的优势比分别为0.25(95%可信区间：0.21，0.31)和0.22(0.17，0.27))。这些关联在心力衰竭、任何心血管疾病和死亡方面都是一致的(相比3-5.9个月的滴度到0%的滴度，几率分别降低63%和60%)，在第一年的随访中只有一次血压得到控制或没有得到控制的人，以及按后续血压测量类别定义的组之间的关联是一致的。根据目前测量血压的频率，这项研究表明，随着时间的推移，很少有新的高血压患者持续一整年的目标血压。更高的效价和更低的心血管疾病风险之间的负相关关系独立于广泛使用的血压控制指标。需要随机试验来评估增加一个人在血压目标上花费的时间的干预措施。
The time a patient spends with blood pressure at target level is an intuitive measure of successful BP management, but population studies on its effectiveness are as yet unavailable. We identified a population-based cohort of 169,082 individuals with newly identified high blood pressure who were free of cardiovascular disease from January 1997 to March 2010. We used 1.64 million clinical blood pressure readings to calculate the TIme at TaRgEt (TITRE) based on current target blood pressure levels. The median (Inter-quartile range) TITRE among all patients was 2.8 (0.3, 5.6) months per year, only 1077 (0.6%) patients had a TITRE ≥11 months. Compared to people with a 0% TITRE, patients with a TITRE of 3–5.9 months, and 6–8.9 months had 75% and 78% lower odds of the composite of cardiovascular death, myocardial infarction and stroke (adjusted odds ratios, 0.25 (95% confidence interval: 0.21, 0.31) and 0.22 (0.17, 0.27), respectively). These associations were consistent for heart failure and any cardiovascular disease and death (comparing a 3–5.9 month to 0% TITRE, 63% and 60% lower in odds, respectively), among people who did or did not have blood pressure ‘controlled’ on a single occasion during the first year of follow-up, and across groups defined by number of follow-up BP measure categories. Based on the current frequency of measurement of blood pressure this study suggests that few newly hypertensive patients sustained a complete, year-round on target blood pressure over time. The inverse associations between a higher TITRE and lower risk of incident cardiovascular diseases were independent of widely-used blood pressure ‘control’ indicators. Randomized trials are required to evaluate interventions to increase a person’s time spent at blood pressure target.
登录
查看更多内容
影响因子：
3.7
作者：
Pujades-Rodriguez, Mar;Timmis, Adam;Hemingway, Harry
通讯作者：
Hemingway, Harry
DOI：
10.1136/bmj.f2350
发表时间：
2013-05-20
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Herrett E;Shah AD;Boggon R;Denaxas S;Smeeth L;van Staa T;Timmis A;Hemingway H
通讯作者：
Hemingway H
影响因子：
3.2
作者：
Giannattasio, Cristina;Cairo, Matteo;Mancia, Giuseppe
通讯作者：
Mancia, Giuseppe
影响因子：
120.7
作者：
Egan, Brent M.;Zhao, Yumin;Axon, R. Neal
通讯作者：
Axon, R. Neal
影响因子：
39.2
作者：
Levey, Andrew S.;Coresh, Josef;Van Lente, Frederick
通讯作者：
Van Lente, Frederick