Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients
Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients
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DOI：
10.1001/archinte.160.8.1085
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发表时间：
2000-04-24
影响因子：
--
通讯作者：
Safar, ME
中科院分区：
文献类型：
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作者：
Blacher, J;Staessen, JA;Safar, ME
背景：目前高血压的治疗指南几乎完全依赖于收缩压和舒张压的测量。目的：探讨脉压和平均压作为老年高血压患者心血管预后决定因素的独立作用。方法：基于患者个人数据，荟萃分析了欧洲老年高血压工作组试验(n=840)、欧洲收缩期高血压试验(n=4695)和中国试验(n=2394)的结果。结果：脉压增加10 mm Hg会增加主要心血管并发症的风险；在控制了平均压力和其他协变量后，所有冠脉终点的风险增加约13%(P=0.02)至心血管死亡率增加近20%(P=.001)。在一项类似的分析中，平均血压预测心血管并发症的发生率，但只有在从模型中去除脉压作为解释变量后。此外，出现主要心血管终点的概率随着收缩压的升高而增加；在任何给定的收缩压水平下，出现主要心血管终点的概率也随着舒张压的降低而增加，这表明较宽的脉压是导致重大并发症风险的原因。结论：在老年高血压患者中，脉压而不是平均压是心血管风险的主要决定因素。这些发现对高血压患者管理的意义应该在随机对照结果试验中进一步调查，在随机对照试验中，血压的脉搏成分受到抗高血压药物治疗的不同影响。
Background: Current guidelines for the management of hypertension rest almost completely on the measurement of systolic and diastolic blood pressure. However, the arterial blood pressure wave is more correctly described as consisting of a pulsatile (pulse pressure) and a steady (mean pressure) component.Objective: To explore the independent roles of pulse pressure and mean pressure as determinants of cardiovascular prognosis in older hypertensive patients.Methods: This meta-analysis, based on individual patient data, pooled the results of the European Working Party on High Blood Pressure in the Elderly trial (n = 840), the Systolic Hypertension in Europe Trial (n = 4695), and the Systolic Hypertension in China Trial (n = 2394). The relative hazard rates associated with pulse pressure and mean pressure were calculated using Cox regression analysis, with stratification for the 3 trials and with adjustments for sex, age, previous cardiovascular complications, smoking, and treatmentResults: A 10-mm Hg wider pulse pressure increased the risk of major cardiovascular complications; after controlling for mean pressure and the other covariates, the increase in risk ranged from approximately 13% for all coronary end points (P = .02) to nearly 20% for cardiovascular mortality (P = .001). In a similar analysis, mean pressure predicted the incidence of cardiovascular complications but only after removal of pulse pressure as an explanatory variable from the model. Furthermore, the probability of a major cardiovascular end point increased with higher systolic blood pressure; at any given level of systolic blood pressure, it also increased with lower diastolic blood pressure, suggesting that the wider pulse pressure was driving the risk of major complications.Conclusions: In older hypertensive patients, pulse pressure not mean pressure is the major determinant of cardiovascular risk. The implications of these findings for the management of hypertensive patients should be further investigated in randomized controlled outcome trials in which the pulsatile component of blood pressure is differently affected by antihypertensive drug treatment.