Predictive utility of pulse pressure and other blood pressure measures for cardiovascular outcomes
Predictive utility of pulse pressure and other blood pressure measures for cardiovascular outcomes
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DOI：
10.1161/hypertensionaha.106.083592
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发表时间：
2007-06-01
期刊：
影响因子：
8.3
通讯作者：
Lloyd-Jones, Donald M.
中科院分区：
文献类型：
--
作者：
Mosley, William J., II;Greenland, Philip;Lloyd-Jones, Donald M.
关于脉压和其他血压测量对心血管事件的实际预测效用的数据很少。我们纳入了来自芝加哥心脏协会工业检测项目的所有参与者，他们在基线（1967-1973年）没有心血管疾病，也没有接受抗高血压治疗。评估基线血压测量对33年内致死性和非致死性事件的预测效用。在36 +/- 314名参与者（平均年龄：39 +/- 13岁; 43.4%为女性）中，有11452人死亡：745人死于中风，2812人死于冠心病，599人死于心力衰竭。在16393名获得医疗保险资格的参与者中，分别有3050、1367和2207人因中风、心肌梗死或心力衰竭住院≥ 1次。在单变量分析中，根据脉搏、收缩压和舒张压的标准差，卒中死亡的风险比分别为1.49、1.75和1.71。Likewise ratio chi（2）（分别为134.3、302.0和232.6），贝叶斯信息标准值（分别为15 142、14 974和15 044）和受试者工作特征曲线下面积（分别为0.59、0.64和0.63）均表明与脉压相比，收缩压和舒张压的预测效用更好。冠状动脉或心力衰竭死亡和中风、心肌梗死或心力衰竭住院的结果相似。脉压在所有年龄段都有较弱的预测效用，尤其是对于那些< 50岁的人。在这项大型队列研究中，脉压对心血管事件的预测效用低于收缩压或舒张压。这些发现支持了当前指南中使用收缩压和舒张压评估风险和治疗需求的方法。
Data are sparse regarding the actual predictive utility of pulse pressure and other blood pressure measures for cardiovascular events. We included all of the participants from the Chicago Heart Association Detection Project in Industry who were free of cardiovascular disease and not receiving antihypertensive treatment at baseline (1967-1973). Baseline blood pressure measures were assessed for predictive utility for fatal and nonfatal events over 33 years. Among 36 +/- 314 participants (mean age: 39 +/- 13 years; 43.4% women), there were 11 452 deaths: 745 were attributed to stroke, 2812 to coronary disease, and 599 to heart failure. Of the 16 393 participants who attained Medicare eligibility, 3050, 1367, and 2207 had >= 1 hospitalization for stroke, myocardial infarction, or heart failure, respectively. In univariate analyses, hazards ratios for stroke death per SD of pulse, systolic, and diastolic pressure, respectively, were 1.49, 1.75, and 1.71. Likelihood ratio chi(2) (134.3, 302.0, and 232.6, respectively), Bayes information criteria values (15 142, 14 974, and 15 044, respectively), and areas under receiver-operating characteristic curves (0.59, 0.64, and 0.63, respectively) all indicated better predictive utility for systolic and diastolic compared with pulse pressure. Results for coronary or heart failure death and stroke, myocardial infarction, or heart failure hospitalization were similar. Pulse pressure had weaker predictive utility at all ages but particularly for those < 50 years. In this large cohort study, pulse pressure had predictive utility for cardiovascular events that was inferior to systolic or diastolic pressure. These findings support the approach of current guidelines in the use of systolic and diastolic blood pressure to assess risk and the need for treatment.