Usual blood pressure, peripheral arterial disease, and vascular risk: cohort study of 4.2 million adults.
Usual blood pressure, peripheral arterial disease, and vascular risk: cohort study of 4.2 million adults.
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DOI：
10.1136/bmj.h4865
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发表时间：
2015-09-29
期刊：
影响因子：
--
通讯作者：
Rahimi K
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作者：
Emdin CA;Anderson SG;Callender T;Conrad N;Salimi-Khorshidi G;Mohseni H;Woodward M;Rahimi K
目的在一个大型当代队列中，确定正常血压与外周动脉疾病风险之间的亚组特异性关联，并研究外周动脉疾病与一系列其他类型血管疾病之间的关系。设计队列研究。在英国设置1990年至2013年的关联电子健康记录。参与者为222,459人，年龄在30-90岁之间，在初级保健诊所登记至少一年，并进行了血压测量。主要观察指标新发外周动脉疾病的首次诊断时间和12种不同血管事件的首次诊断时间。结果收缩压高于正常20 mm Hg与外周动脉疾病的风险增加63%相关（风险比1.63,95%可信区间1.59 ~ 1.66）。相关性强度随年龄和体重指数的增加而下降（交互作用P<0.001），但不受性别或吸烟状况的影响。外周动脉疾病与11种不同血管事件的风险增加相关，包括缺血性心脏病（1.68,1.58至1.79）、心力衰竭（1.63,1.52至1.75）、主动脉瘤（2.10,1.79至2.45）和慢性肾脏疾病（1.31,1.25至1.38），但与出血性中风无关。外周动脉疾病患者最常见的初始血管事件是慢性肾病（24.4%的初始事件），其次是缺血性心脏病（18.5%的初始事件）、心力衰竭（14.7%）和心房颤动（13.2%）。当我们在两个荟萃分析中汇总结果时，该队列的总体估计与传统研究的结果一致。结论：在一系列患者亚组中，血压升高是外周动脉疾病的一个重要危险因素。此外，临床医生应该意识到，患有外周动脉疾病的患者发生一系列其他血管事件的风险增加，包括慢性肾病、缺血性心脏病、心力衰竭、心房颤动和中风。
Objectives To determine the subgroup specific associations between usual blood pressure and risk of peripheral arterial disease, and to examine the relation between peripheral arterial disease and a range of other types of vascular disease in a large contemporary cohort. Design Cohort study. Setting Linked electronic health records from 1990 to 2013 in the United Kingdom. Participants 4 222 459 people aged 30-90 years, registered at a primary care practice for at least one year and with a blood pressure measurement. Main outcome measures Time to first diagnosis of new onset peripheral arterial disease and time to first diagnosis of 12 different vascular events. Results A 20 mm Hg higher than usual systolic blood pressure was associated with a 63% higher risk of peripheral arterial disease (hazard ratio 1.63, 95% confidence interval 1.59 to 1.66). The strength of the association declined with increasing age and body mass index (P<0.001 for interaction) but was not modified by sex or smoking status. Peripheral arterial disease was associated with an increased risk of 11 different vascular events, including ischaemic heart disease (1.68, 1.58 to 1.79), heart failure (1.63, 1.52 to 1.75), aortic aneurysm (2.10, 1.79 to 2.45), and chronic kidney disease (1.31, 1.25 to 1.38), but not haemorrhagic stroke. The most common initial vascular event among those with peripheral arterial disease was chronic kidney disease (24.4% of initial events), followed by ischaemic heart disease (18.5% of initial events), heart failure (14.7%), and atrial fibrillation (13.2%). Overall estimates from this cohort were consistent with those derived from traditional studies when we pooled the findings in two meta-analyses. Conclusions Raised blood pressure is a strong risk factor for peripheral arterial disease in a range of patient subgroups. Furthermore, clinicians should be aware that those with established peripheral arterial disease are at an increased risk of a range of other vascular events, including chronic kidney disease, ischaemic heart disease, heart failure, atrial fibrillation, and stroke.