High central pulse pressure is independently associated with adverse cardiovascular outcome the strong heart study.
High central pulse pressure is independently associated with adverse cardiovascular outcome the strong heart study.
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DOI：
10.1016/j.jacc.2009.05.070
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发表时间：
2009-10-27
影响因子：
24
通讯作者：
Howard, Barbara V.
中科院分区：
文献类型：
--
作者：
Roman, Mary J.;Devereux, Richard B.;Kizer, Jorge R.;Okin, Peter M.;Lee, Elisa T.;Wang, Wenyu;Umans, Jason G.;Calhoun, Darren;Howard, Barbara V.
为了促进中心PP的临床应用，我们试图确定一个可以预测不良后果的值，从而为评估干预策略提供一个目标。我们之前的研究表明，中枢脉压（PP）与颈动脉肥大和动脉粥样硬化程度的关系更密切，更重要的是，与肱脉压相比，它能更好地预测心血管疾病（CVD）的发生。在第三次强心脏研究检查中，我们采用了桡动脉压测法来确定中枢血压。使用预先指定的协变量和中央和肱PP的四分位数进行Cox回归分析。在2405名没有流行CVD的参与者中，344名在5.6±1.7年期间发生了CVD事件。中央PP的四分位数（p<0.001）比臂PP的四分位数（p=0.052）更能预测预后。校正协变量后，只有中心PP（≥50 mmHg）的第4四分位数的事件发生率显著高于第1四分位数（HR 1.69, 95% CI: 1.20-2.39, p=0.003）。中心PP≥50 mmHg与男性（HR 2.06, 95% CI: 1.39-3.04, p<0.001）和女性（HR 2.03, 95% CI: 1.55-2.65, p<0.001）的预后相关；有糖尿病（HR 1.84, 95% CI: 1.41-2.39, p<0.001）和无糖尿病（HR 1.91, 95% CI: 1.29-2.83, p=0.001）的受试者；60岁以下（HR 2.51, 95% CI: 1.59-3.95, p<0.001）和60岁以上（HR 1.53, 95% CI: 1.19-1.97, p=0.001）的人群中。如果在其他人群和前瞻性研究中得到证实，中心PP≥50 mmHg可预测不良CVD结果，可作为干预策略的目标。
To facilitate clinical use of central PP, we sought to determine a value that might predict adverse outcome and thereby provide a target for assessment of intervention strategies. We previously documented that central pulse pressure (PP) more strongly relates to carotid hypertrophy and extent of atherosclerosis and, more importantly, better predicts incident cardiovascular disease (CVD) than brachial PP. Radial applanation tonometry was performed in the 3rd Strong Heart Study exam to determine central blood pressure. Cox regression analyses were performed using pre-specified covariates and quartiles of central and brachial PP. Among 2,405 participants without prevalent CVD, 344 suffered CVD events during 5.6±1.7 years. Quartiles of central PP (p<0.001) predicted outcome more strongly than quartiles of brachial PP (p=0.052). With adjustment for covariates, only the event rate in the 4th quartile of central PP (≥50 mmHg) was significantly higher than that in the first quartile (HR 1.69, 95% CI: 1.20–2.39, p=0.003). Central PP ≥50 mmHg was related to outcome in both men (HR 2.06, 95% CI: 1.39–3.04, p<0.001) and women (HR 2.03, 95% CI: 1.55–2.65, p<0.001); in participants with (HR 1.84, 95% CI: 1.41–2.39, p<0.001) and without diabetes (HR 1.91, 95% CI: 1.29–2.83, p=0.001); and in individuals below (HR 2.51, 95% CI: 1.59–3.95, p<0.001) and above (HR 1.53, 95% CI: 1.19–1.97, p=0.001) the age of 60. Central PP ≥50 mmHg predicts adverse CVD outcome and may serve as a target in intervention strategies, if confirmed in other populations and in prospective studies.
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