FACTORS ASSOCIATED WITH PARADOXICAL SURVIVAL AT HIGHER BLOOD PRESSURES IN THE VERY OLD
FACTORS ASSOCIATED WITH PARADOXICAL SURVIVAL AT HIGHER BLOOD PRESSURES IN THE VERY OLD
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DOI：
10.1093/oxfordjournals.aje.a115990
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发表时间：
1991-07-01
影响因子：
5
通讯作者：
BARRETTCONNOR, E
中科院分区：
文献类型：
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作者：
LANGER, RD;GANIATS, TG;BARRETTCONNOR, E
矛盾的是，芬兰的一项人口研究报告称，85岁及以上高血压患者的存活率更高(BR Med J 1988；296：887-9)。在之前的一份报告中，作者在兰乔贝尔纳多慢性病研究(BR Med J 1989；298：1356-7)中证明，75岁及以上男性(但不是女性)的舒张压增加，可以改善10年的存活率。然而，在该分析中使用的访问中，几乎没有获得能够潜在地解释这种影响的协变量。为了证实这些自相矛盾的生存报告并探索其可能的原因，作者分析了795名年龄在75-96岁(平均80.6岁)的男性和女性的全原因和心血管死亡率，这些人在1984-1987年进行了评估，并在综合检查后前瞻性地进行了平均3年的跟踪调查。在63例死亡中，48例(76%)为男性；43例(68%)死于心血管疾病。Kaplan-Meier生存分析显示，随着80岁及以上男性的舒张压增加，与全因死亡率(X-2 p小于或等于0.01)和心血管死亡率(X-2 p小于或等于0.00)相比，存活率有显著提高的趋势。这些趋势在80岁以下的男性或这两个年龄段的女性中都不明显。结果不能用降压药的使用、脉压、高血压病史、冠心病病史、单纯的收缩期高血压、舒张压的间隔变化(平均12年)或胆固醇、甘油三酯、空腹血糖、吸烟或体重指数来解释。因此，在舒张压较高的80岁或80岁以上男性中，全因和心血管存活率的改善之间的矛盾关系并不能用广泛的生物和历史因素来解释。
Paradoxically greater survival for persons aged 85 years and older with higher blood pressures has been reported in a Finnish population study (Br Med J 1988; 296:887-9). In a previous report, the authors demonstrated improved 10-year survival with increasing diastolic blood pressure in men (but not in women) aged 75 years and older in the Rancho Bernardo Chronic Disease Study (Br Med J 1989; 298:1356-7). However, few of the covariates which could potentially explain this effect were obtained at the visit used in that analysis. In an effort to confirm these reports of paradoxical survival and to explore possible reasons for them, the authors analyzed all-cause and cardiovascular mortality in 795 men and women aged 75-96 years (mean, 80.6), evaluated in 1984-1987 and followed prospectively for an average of 3 years after that comprehensive examination. Of 63 deaths, 48 (76%) were in men; 43 (68%) of all deaths were cardiovascular. Kaplan-Meier survival analyses showed a significant trend for improved survival with increasing diastolic pressure in men aged 80 years and older versus all-cause mortality (chi-2 p less-than-or-equal-to 0.01), and cardiovascular mortality (chi-2 p less-than-or-equal-to 0.00). These trends were not evident in men aged less than 80 years or in women in either age group. Results were not explained by differences in the use of antihypertensive medication, pulse pressure, history of hypertension, history of coronary heart disease, isolated systolic hypertension, interval change in diastolic pressure (over an average of 12 years), or by cholesterol, triglycerides, fasting plasma glucose, smoking, or body mass index. Thus, the paradoxical relation of improved all-cause and cardiovascular survival in men aged 80 years or older with higher diastolic pressure is not explained by a wide range of biologic and historical factors.