Influence of systolic and diastolic blood pressure on the risk of incident atrial fibrillation in women.
Influence of systolic and diastolic blood pressure on the risk of incident atrial fibrillation in women.
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DOI：
10.1161/circulationaha.108.830042
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发表时间：
2009-04-28
期刊：
影响因子：
37.8
通讯作者：
Albert CM
中科院分区：
文献类型：
--
作者：
Conen D;Tedrow UB;Koplan BA;Glynn RJ;Buring JE;Albert CM
在最初健康的中年女性中，收缩压和舒张压（BP）对房颤（AF）事件的影响还没有得到很好的研究。对34221名参与妇女健康研究的妇女进行了前瞻性房颤事件随访。使用考克斯比例风险模型比较了收缩压和舒张压类别的房颤风险。在12.4年的随访期间，发生了644起AF事件。使用基线时的血压测量值，房颤的长期风险在收缩压和舒张压类别中显著增加。多变量校正的风险比（HR）收缩压类别（95%置信区间（CI））（<120、120-129、130-139、140-159和≥160 mmHg）分别为1.0、1.00（0.78-1.28）、1.28（1.00-1.63）、1.56（1.22-2.01）和2.74（1.77-4.22）（趋势p <0.0001）。各基线舒张压类别的校正HR（95% CI）（<65，65-74，75-84，85-89，90-94，≥95 mmHg）分别为1.0，1.17（0.81-1.69）、1.18（0.84-1.65）、1.53（1.05-2.23）、1.35（0.82-2.22）和2.15（1.21-3.84）（趋势p 0.004）。当在更新的模型中考虑BP随时间的变化时，多变量校正HR（95% CI）为1.0，1.14（0.89- 1.46）、1.37（1.07-1.76）、1.71（1.33-2.21）和2.21（1.45-3.36）收缩压类别（趋势p <0.0001），1.0，1.12舒张压类别分别为（0.82-1.52）、1.13（0.83-1.52）、1.30（0.89-1.88）、1.50（1.01-1.88）和1.54（0.75-3.14）（趋势p <0.026）。在这一大型队列的初始健康女性中，BP与AF事件密切相关，收缩压是比舒张压更好的预测因子。即使考虑到血压随时间的变化，非高血压范围内的收缩压水平与房颤事件独立相关。
The influence of systolic and diastolic blood pressure (BP) on incident atrial fibrillation (AF) is not well studied among initially healthy, middle-aged women. 34221 women participating in the Women’s Health Study were prospectively followed for incident AF. The risk of AF across categories of systolic and diastolic BP was compared using Cox proportional-hazards models. During 12.4 years of follow-up, 644 incident AF events occurred. Using BP measurements at baseline, the long-term risk of AF was significantly increased across categories of systolic BP and diastolic BP. Multivariable adjusted hazard ratios (HR) (95% confidence interval (CI)) for systolic BP categories (<120, 120–129, 130–139, 140–159 and ≥160 mmHg) were 1.0, 1.00 (0.78–1.28), 1.28 (1.00–1.63), 1.56 (1.22–2.01) and 2.74 (1.77–4.22) (p for trend <0.0001). Adjusted HRs (95% CI) across baseline diastolic BP categories (<65, 65–74, 75–84, 85–89, 90–94, ≥95 mmHg) were 1.0, 1.17 (0.81–1.69), 1.18 (0.84–1.65), 1.53 (1.05–2.23), 1.35 (0.82–2.22) and 2.15 (1.21–3.84) (p for trend 0.004). When BP changes over time were accounted for in updated models, multivariable adjusted HRs (95% CI) were 1.0, 1.14 (0.89– 1.46), 1.37 (1.07–1.76), 1.71 (1.33–2.21) and 2.21 (1.45–3.36) (p for trend <0.0001) for systolic BP categories, and 1.0, 1.12 (0.82–1.52), 1.13 (0.83–1.52), 1.30 (0.89–1.88), 1.50 (1.01–1.88) and 1.54 (0.75–3.14) (p for trend 0.026) for diastolic BP categories. In this large cohort of initially healthy women, BP was strongly associated with incident AF, and systolic BP was a better predictor than diastolic BP. Systolic BP levels within the non-hypertensive range were independently associated with incident AF even after taking into account BP changes over time.