Do estimated 24-h pulse pressure components affect outcome? The Ohasama study
Do estimated 24-h pulse pressure components affect outcome? The Ohasama study
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DOI：
10.1097/hjh.0000000000002366
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发表时间：
2020-07-01
影响因子：
4.9
通讯作者：
Ohkubo, Takayoshi
中科院分区：
文献类型：
--
作者：
Bursztyn, Michael;Kikuya, Masahiro;Ohkubo, Takayoshi
目的：24小时动态脉压（PP）是预后的有力预测指标。我们试图应用最近描述的PP组件，弹性（elPP）和收缩硬化（stPP）组件从24小时动态血压（BP）监测（AMBP），并检查其对Ohasama研究人群的结果的影响。设计和方法：包括Ohasama研究中没有心血管疾病（CVD）病史的参与者，随访总死亡率和CVD死亡率以及卒中发病率。使用基于动脉中表达压力刚度关系的非线性压力-容积关系的模型，从24小时SBP和DBP推导PP分量。通过考克斯回归模型估计结局预测能力;风险比和95%置信区间（CI），适用于ePP和stPP，适当时校正年龄、性别、BMI、吸烟、饮酒、糖尿病、总胆固醇、抗高血压治疗和平均动脉压（MAP）。结果：在1745名参与者（年龄61.4 ± 11.6，65%为女性）中，580人死亡，212人死于CVD，290人在17年随访期间发生卒中。PP与elPP（r = 0.89）相关性较强，与stPP（r = 0.58）相关性较弱，两者相关性较弱（r = 0.15）。校正后，总死亡率、CVD死亡率和卒中发病率每1 SD增量的PP风险比分别为1.095（95% CI 0.973-1.232）、1.207（1.000-1.456）和0.983（0.829-1.166）。ePP和stPP的相应风险比和95% CI无显著性。然而，在中位脉率为68.5 bpm或更低（中位数，n = 872）的参与者中，通过ePP（每1 SD增量）预测总死亡率（327例死亡）和CVD死亡率（131例死亡），风险比分别为1.231（95%CI，1.082-1.401）和1.294（95%CI，1.069-1.566）。在接受治疗的高血压和脉率≤ 68.5 bpm的受试者亚组（n = 309）中，通过ePP预测总死亡率（177例死亡）和CVD死亡率（77例死亡），风险比分别为1.357（95%CI，1.131-1.628）和1.417（95%CI，1.092-1.839）。卒中发病率不能通过PP或PP组分预测。结论：在日本农村人群中，即使在脉率较慢的亚群中调整MAP和传统危险因素，elPP而不是stPP也可预测总死亡率和CVD死亡率。这主要发生在接受治疗的高血压患者中。
Objective: Twenty-four-hour ambulatory pulse pressure (PP) is a powerful predictor of outcome. We attempted to apply the recently described PP components, an elastic (elPP), and systolic stiffening (stPP) components from 24-h ambulatory blood pressure (BP) monitoring (AMBP), and examine their influence on outcome in the Ohasama study population. Design and methods: Included were participants of the Ohasama study without history of cardiovascular disease (CVD), who were followed-up for total and CVD mortality, and for stroke morbidity. The PP components were derived from 24-h SBP and DBP using a model based on the nonlinear pressure--volume relationship in arteries expressing pressure stiffness relationship. Outcome predictive power was estimated by Cox regression models; hazard ratio with 95% confidence interval (CI), applied to elPP, and stPP, adjusted for age, sex, BMI, smoking, alcohol drinking, diabetes mellitus, total cholesterol, antihypertensive treatment, and mean arterial pressure (MAP), whenever appropriate. Results: Of 1745 participants (age 61.4 +/- 11.6, 65% women), 580 died, 212 of CVD, and 290 experienced a stroke during 17 follow-up years. PP was strongly correlated with elPP (r = 0.89) and less so with stPP (r = 0.58), and the correlation between the two components was weak (r = 0.15). After the adjustment, hazard ratio of PP per 1 SD increment for total mortality, CVD mortality, and stroke morbidity were 1.095 (95% CI 0.973-1.232), 1.207 (1.000-1.456), and 0.983 (0.829-1.166), respectively. Corresponding hazard ratios and 95% CIs were nonsignificant for elPP, and stPP. However, among participants with median pulse rate 68.5 bpm or less (median,n = 872), total (327 deaths) and CVD (131 deaths) mortality were predicted by elPP (per 1 SD increment), hazard ratio 1.231 (95% CI, 1.082-1.401), and 1.294 (95% CI, 1.069-1.566), respectively. In the subgroup of treated participants with hypertension and pulse rate 68.5 or less bpm (n = 309), total (177 deaths) and CVD (77 deaths) mortality were predicted by elPP, hazard ratio of 1.357 (95% CI, 1.131-1.628), and 1.417 (95% CI, 1.092-1.839), respectively. Stroke morbidity was not predicted by either PP or the PP components. Conclusion: In a rural Japanese population, elPP but not stPP was predictive of total and CVD mortality even when adjusted for MAP and conventional risk factors in the subpopulation with slower pulse rate. This was mostly among the treated hypertensive patients.