CARDIOVASCULAR REACTIVITY TO THE COLD PRESSOR TEST AS A PREDICTOR OF HYPERTENSION
CARDIOVASCULAR REACTIVITY TO THE COLD PRESSOR TEST AS A PREDICTOR OF HYPERTENSION
复制标题
DOI：
10.1161/01.hyp.14.5.524
复制
发表时间：
1989-11-01
期刊：
影响因子：
8.3
通讯作者：
PEARSON, TA
中科院分区：
文献类型：
--
作者：
MENKES, MS;MATTHEWS, KA;PEARSON, TA
心血管对应激的反应性被认为是随后神经源性心血管疾病的标志，但关于这一假说的前瞻性研究很少。我们研究了910名白人男性医学生，他们在1948-1964年的冷加压试验之前和期间测量了他们的血压和脉率。高血压状况(需要药物治疗)在20到36年的随访期内通过年度问卷调查来确定。观察到最大收缩压变化与后来的高血压之间的关系，在44岁时，收缩压上、中两和最低四分位数的收缩压变化的累积高血压发病率分别为6.7%、3.0%和2.4%(Kaplan-Meier，p<；0.02)。在COX模型中，调整了研究开始年龄、克托莱指数、吸烟、试验前的收缩压以及父亲或母亲的高血压病史后，这种关联仍然存在。与收缩压反应性相关的额外风险在20岁左右的人群中并不明显，在45岁之前发展为高血压的人中最为明显(相对风险=2.5，20毫米汞变化的95%可信区间=1.47，4.71)。舒张压和心率的变化与后来的高血压无关。这些数据表明，易患高血压的人在年轻时就表现出生理上的改变。
Cardiovascular reactivity to stress is hypothesized to be a marker for subsequent neurogenic cardiovascular disease, but few prospective studies of this hypothesis are available. We studied 910 white male medical students who had their blood pressure and pulse rate measured before and during a cold pressor test in the years 1948-1964. Hypertensive status (requiring drug treatment) was ascertained by annual questionnaires in the 20- to 36-year follow-up period. An association was observed between maximum change in systolic blood pressure and later hypertension, with a cumulative incidence of hypertension by age 44 of 6.7%, 3.0%, and 2.4% for a change in systolic blood pressure in the upper, middle two, and lowest quartiles, respectively (Kaplan-Meier, p < 0.02). After adjustment for study entry age, Quetelet Index, cigarette smoking, pretest systolic blood pressure, and paternal or maternal history of hypertension in a Cox model, the association persisted. The excess risk associated with systolic blood pressure reactivity was not apparent until the population aged some 20 years and was most apparent among those in whom hypertension developed before age 45 (relative risk = 2.5, 95% confidence intervals = 1.47, 4.71 for a 20 mm Hg change). Diastolic blood pressure and heart rate changes were not associated with later hypertension. These data suggest that persons prone to later hypertension manifest an altered physiology at a young age.