Pulse pressure and risk for myocardial infarction and heart failure in the elderly
Pulse pressure and risk for myocardial infarction and heart failure in the elderly
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DOI：
10.1016/s0735-1097(00)00687-2
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发表时间：
2000-07-01
影响因子：
24
通讯作者：
Krumholz, HM
中科院分区：
文献类型：
--
作者：
Vaccarino, V;Holford, TR;Krumholz, HM
我们试图确定脉压（PP），一种动脉硬度的测量方法，是否是冠心病（CHD）发病率的独立预测因子，目前的高血压指南根据收缩压（SBP）或舒张压（DBP）升高对心血管风险进行分类，而不考虑它们的综合影响。最近的研究表明，PP是一个强有力的预测心血管终点，但很少有数据可在社区elderize.METHODS研究样本包括2,152个人年龄大于或等于65岁，谁是参与者的老年人流行病学研究计划，免费的CHD和CHF在基线和仍然活着后，在一个后方登记。在基线时测量血压。结果10年间共发生CHD 328例，CHF 224例，全因死亡1,046例。脉压与各终点呈强线性关系。校正人口统计学、合并症和CHD风险因素后，PP增加10 mm Hg与CHD风险增加12%（95%置信区间[CI]，2%-22%）、CHF风险增加14%（95% CI，5%-24%）和总死亡率增加6%（95% CI，0%-12%）相关。虽然SEP和平均动脉压（MAP）也显示与终点呈正相关，但PP产生最高的似然比卡方。当PP与其他血压参数（分别为SBP、DBP、MAP或高血压分期）一起输入模型时，PP的相关性保持为正，但其他血压变量的相关性变为负。PP的效果持续调整后，目前的药物使用，并存在于血压正常的个人和个人与孤立的收缩期高血压，但不是在个人与舒张期高血压。结论PP升高是一个强大的独立预测心血管终点在老年人。J Am Coil Cardiol 2000;36：130-8）（C）2000年美国心脏病学会。
OBJECTIVES We sought to determine whether pulse pressure (PP), a measure of arterial stiffness, is an independent predictor of the incidence of coronary heart disease (CHD), congestive heart failure (CHF) and overall mortality among community-dwelling elderly.BACKGROUND Current hypertension guidelines classify cardiovascular risk on the basis of elevated systolic blood pressure (SBP) or diastolic blood pressure (DBP) without considering their combined effects. Recent studies suggest that PP is a strong predictor of cardiovascular end points, but few data are available among community elderly.METHODS The study sample included 2,152 individuals age greater than or equal to 65 years, who were participants in the Established Populations for Epidemiologic Study of the Elderly program, free of CHD and CHF at baseline and still alive at one rear after enrollment. Blood pressure was measured at baseline. Incidence of CHD, incidence of CHF and total mortality were monitored in the following 10 years.RESULTS There were 328 incident CHD events, 224 incident CHF events and 1,046 persons who died of any cause. Pulse pressure showed a strong and linear relationship with each end point. After adjusting for demographics, comorbidity and CHD risk factors, a 10-mm Hg increment in PP was associated with a 12% increase in CHD risk (95% confidence interval [CI], 2% to 22%), a 14% increase in CHF risk (95% CI, 5% to 24%), and a 6% increase in overall mortality (95% CI, 0% to 12%). While SEP and mean arterial pressure (MAP) also showed positive associations with the end points, PP yielded the highest likelihood ratio chi-square. When PP was entered in the model in conjunction with other blood pressure parameters (SBP, DBP, MAP or hypertension stage, respectively), the association remained positive for PP but became negative for the other blood pressure variables. The effect of PP persisted after adjusting for current medication use and was present in normotensive individuals and individuals with isolated systolic hypertension but not in individuals with diastolic hypertension.CONCLUSION Elevated PP is a powerful independent predictor of cardiovascular end points in the elderly. J Am Coil Cardiol 2000;36:130-8) (C) 2000 by the American College of Cardiology.