Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies
Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies
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DOI：
10.1016/s0140-6736(02)11911-8
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发表时间：
2002-12-14
期刊：
影响因子：
168.9
通讯作者：
Collins, R
中科院分区：
文献类型：
--
作者：
Lewington, S;Clarke, R;Collins, R
背景
通过对来自不同前瞻性研究的个体参与者数据进行协作荟萃分析，能最好地评估血压与特定病因死亡率的年龄特异性相关性。
方法
在61项关于血压和死亡率的前瞻性观察研究中，获取了100万基线时无既往血管疾病记录的成年人中每个人的信息。在1270万人年的风险期间，在40 - 89岁年龄段约有56000例血管性死亡（12000例卒中，34000例缺血性心脏病[IHD]，10000例其他血管疾病）以及66000例其他死亡。荟萃分析涉及对回归稀释进行“时间依赖性”校正，将死亡时每个年龄段的死亡率与该年龄段开始时估计的通常血压相关联。
结果
在死亡时的每个年龄段内，与通常血压的给定绝对差值相关的血管性死亡风险的比例差异，至少在通常收缩压（SBP）降至115 mmHg和通常舒张压（DBP）降至75 mmHg时大致相同，在此之下几乎没有证据。在40 - 69岁年龄段，通常SBP每相差20 mmHg（或大致相当于通常DBP相差10 mmHg），卒中死亡率的差异超过两倍，IHD和其他血管原因导致的死亡率差异也达两倍。在80 - 89岁年龄段，所有这些血管死亡率的比例差异大约是40 - 49岁年龄段的一半，但老年时风险的年度绝对差异更大。年龄特异性关联在男性和女性以及脑出血和脑缺血中相似。对于通过单次血压测量预测血管死亡率，SBP和DBP的平均值比单独使用其中任何一个略具信息量，而脉压的信息量则少得多。
解释
在整个中年和老年时期，通常血压与血管（及总体）死亡率密切且直接相关，至少在115/75 mmHg以下没有任何阈值的证据。
Background The age-specific relevance of blood pressure to cause-specific mortality is best assessed by collaborative meta-analysis of individual participant data from the separate prospective studies.Methods Information was obtained on each of one million adults with no previous vascular disease recorded at baseline in 61 prospective observational studies of blood pressure and mortality. During 12.7 million person-years at risk, there were about 56 000 vascular deaths (12 000 stroke, 34000 ischaemic heart disease [IHD], 10000 other vascular) and 66 000 other deaths at ages 40-89 years. Meta-analyses, involving "time-dependent" correction for regression dilution, related mortality during each decade of age at death to the estimated usual blood pressure at the start of that decade.Findings Within each decade of age at death, the proportional difference in the risk of vascular death associated with a given absolute difference in usual blood pressure is about the same down to at least 115 mm Hg usual systolic blood pressure (SBP) and 75 mm Hg usual diastolic blood pressure (DBP), below which there is little evidence. At ages 40-69 years, each difference of 20 mm Hg usual SBP (or, approximately equivalently, 10 mm Hg usual DBP) is associated with more than a twofold difference in the stroke death rate, and with twofold differences in the death rates from IHD and from other vascular causes. All of these proportional differences in vascular mortality are about half as extreme at ages 80-89 years as at,ages 40-49 years, but the annual absolute differences in risk are greater in old age. The age-specific associations are similar for men and women, and for cerebral haemorrhage and cerebral ischaemia. For predicting vascular mortality from a single blood pressure measurement, the average of SBP and DBP is slightly more informative than either alone, and pulse pressure is much less informative.Interpretation Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.