上海老年人四肢血压差别异常的患病情况及相关因素
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摘要
目的·研究上海市老年人群中四肢血压差别异常的患病情况及相关因素。方法·2016—2018年,整群抽取上海青浦区赵巷镇60岁及以上老年人。收集一般资料,测量身高、体质量、血压等,抽取空腹静脉血,检测血常规、血糖、血脂、血肌酐等生化指标;并使用动脉硬化检测仪同时测量四肢血压,计算踝臂指数、双臂间收缩压差值和双踝间收缩压差值等指标。多元Logistic回归分析四肢血压差别异常的相关因素。结果·共纳入4 090名研究对象,平均年龄为(68.5±7.6)岁,其中男性占44.6%。高血压和糖尿病患者分别占60.1%和8.6%;踝臂指数≤0.90、双臂间收缩压差值≥15 mmHg(1 mmHg=0.133 kPa)及双踝间收缩压差值≥15 mmHg的患病率分别为2.7%、1.9%和8.4%。在纳入年龄、性别、体质量指数(BMI)、吸烟、饮酒、高血压、糖尿病、总胆固醇、三酰甘油等因素后,多元Logistic回归分析结果显示,年龄、高血压是3个四肢血压差别指标异常的相关因素;踝臂指数≤0.90的相关因素还包括糖尿病、总胆固醇及吸烟;双臂间血压差值≥15 mmHg的相关因素还包括BMI;双踝间血压差值≥15 mmHg的相关因素还包括BMI及糖尿病。结论·四肢血压差别异常在上海老年人群中较常见,高龄、高血压、糖尿病、血脂异常以及肥胖、吸烟等是上海老年人四肢血压差别异常的危险因素。
Objective · To investigate the prevalence and related factors of abnormal four-limb blood pressure difference in elderly people in Shanghai.Methods · From 2016 to 2018, the elderly aged 60 years and over in Zhaoxiang Town, Qingpu District, Shanghai were selected by cluster sampling.General data was collected. Height, body mass, and blood pressure were measured. Fasting venous blood was taken for routine blood test, blood glucose,blood lipids, serum creatinine and other biochemical indicators. Four limb blood pressures were measured simultaneously by Vascular Profiler-1000 device, from which ankle-brachial index, inter-arm systolic pressure difference and inter-ankle systolic pressure difference were calculated. Multivariate Logistic regression was used to analyze the related factors of abnormal four-limb blood pressure difference. Results · A total of 4 090 subjects were enrolled with an average age of(68.5±7.6) years, of which 44.6% were males. The people with hypertension and diabetes mellitus accounted for 60.1%and 8.6%, respectively. The prevalence of ankle-brachial index ≤0.90, inter-arm systolic pressure difference ≥15 mmHg(1 mmHg=0.133 kPa) and inter-ankle systolic pressure difference ≥15 mmHg were 2.7%, 1.9%, and 8.4%, respectively. After incorporating age, sex, body mass index(BMI),smoking, drinking, hypertension, diabetes mellitus, total cholesterol and triacylglycerol, the results of multiple Logistic regression analysis showed that age and hypertension were the related factors of the three indicators for abnormal four-limb blood pressure difference. The related factors of ankle-brachial index≤0.90 also included diabetes mellitus, total cholesterol and smoking; the related factors of inter-arm systolic pressure difference ≥15 mmHg also included BMI; the related factors of inter-ankle systolic pressure difference ≥15 mmHg also included BMI and diabetes mellitus. Conclusion · Abnormal four-limb blood pressure difference is prevalent among the elderly in Shanghai, of which old age, hypertension, diabetes, dyslipidemia, obesity and smoking are risk factors.
Objective · To investigate the prevalence and related factors of abnormal four-limb blood pressure difference in elderly people in Shanghai.Methods · From 2016 to 2018, the elderly aged 60 years and over in Zhaoxiang Town, Qingpu District, Shanghai were selected by cluster sampling.General data was collected. Height, body mass, and blood pressure were measured. Fasting venous blood was taken for routine blood test, blood glucose,blood lipids, serum creatinine and other biochemical indicators. Four limb blood pressures were measured simultaneously by Vascular Profiler-1000 device, from which ankle-brachial index, inter-arm systolic pressure difference and inter-ankle systolic pressure difference were calculated. Multivariate Logistic regression was used to analyze the related factors of abnormal four-limb blood pressure difference. Results · A total of 4 090 subjects were enrolled with an average age of(68.5±7.6) years, of which 44.6% were males. The people with hypertension and diabetes mellitus accounted for 60.1%and 8.6%, respectively. The prevalence of ankle-brachial index ≤0.90, inter-arm systolic pressure difference ≥15 mmHg(1 mmHg=0.133 kPa) and inter-ankle systolic pressure difference ≥15 mmHg were 2.7%, 1.9%, and 8.4%, respectively. After incorporating age, sex, body mass index(BMI),smoking, drinking, hypertension, diabetes mellitus, total cholesterol and triacylglycerol, the results of multiple Logistic regression analysis showed that age and hypertension were the related factors of the three indicators for abnormal four-limb blood pressure difference. The related factors of ankle-brachial index≤0.90 also included diabetes mellitus, total cholesterol and smoking; the related factors of inter-arm systolic pressure difference ≥15 mmHg also included BMI; the related factors of inter-ankle systolic pressure difference ≥15 mmHg also included BMI and diabetes mellitus. Conclusion · Abnormal four-limb blood pressure difference is prevalent among the elderly in Shanghai, of which old age, hypertension, diabetes, dyslipidemia, obesity and smoking are risk factors.
引文
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[15]Weatherley BD,Nelson JJ,Heiss G,et al.The association of the anklebrachial index with incident coronary heart disease:the Atherosclerosis Risk in Communities(ARIC)study,1987-2001[J].BMC Cardiovasc Disord,2007,7:3.
[16]Guo X,Li J,Pang W,et al.Sensitivity and specificity of ankle-brachial index for detecting angiographic stenosis of peripheral arteries[J].Circ J,2008,72(4):605-610.
[17]Verberk WJ,Kollias A,Stergiou GS.Automated oscillometric determination of the ankle-brachial index:a systematic review and meta-analysis[J].Hypertens Res,2012,35(9):883-891.
[18]Clark CE,Campbell JL,Evans PH,et al.Prevalence and clinical implications of the inter-arm blood pressure difference:a systematic review[J].J Hum Hypertens,2006,20(12):923-931.
[19]Hirsch AT,Criqui MH,Treat-Jacobson D,et al.Peripheral arterial disease detection,awareness,and treatment in primary care[J].JAMA,2001,286(11):1317-1324.
[2]Van Bemmel T,Gussekloo J,Westendorp RG,et al.In a population-based prospective study,no association between high blood pressure and mortality after age 85 years[J].J Hypertens,2006,24(2):287-292.
[3]Clark CE.Difference in blood pressure between arms might reflect peripheral vascular disease[J].BMJ,2001,323(7309):399-400.
[4]Aboyans V,Criqui MH,McDermott MM,et al.The vital prognosis of subclavian stenosis[J].J Am Coll Cardiol,2007,49(14):1540-1545.
[5]Sheng CS,Liu M,Zeng WF,et al.Four-limb blood pressure as predictors of mortality in elderly Chinese[J].Hypertension,2013,61(6):1155-1160.
[6]Cortez-Cooper MY,Supak JA,Tanaka H.A new device for automatic measurements of arterial stiffness and ankle-brachial index[J].Am J Cardiol,2003,91(12):1519-1522,A9.
[7]Pan CR,Staessen JA,Li Y,et al.Comparison of three measures of the anklebrachial blood pressure index in a general population[J].Hypertens Res,2007,30(6):555-561.
[8]Williams B,Mancia G,Spiering W,et al.2018 ESC/ESH Guidelines for the management of arterial hypertension[J].Eur Heart J,2018,39(33):3021-3104.
[9]The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus.Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus[J].Diabetes Care,2003,26(Suppl 1):S5-S20.
[10]Clark CE,Taylor RS,Shore AC,et al.Association of a difference in systolic blood pressure between arms with vascular disease and mortality:a systematic review and meta-analysis[J].Lancet,2012,379(9819):905-914.
[11]Singh S,Sethi A,Singh M,et al.Simultaneously measured inter-arm and interleg systolic blood pressure differences and cardiovascular risk stratification:a systemic review and meta-analysis[J].J Am Soc Hypertens,2015,9(8):640-650.
[12]Li X,Luo Y,Xu Y,et al.Relationship of ankle-brachial index with all-cause mortality and cardiovascular mortality after a 3-year follow-up:the China ankle-brachial index cohort study[J].J Hum Hypertens,2010,24(2):111-116.
[13]Woo J,Lynn H,Wong SY,et al.Correlates for a low ankle-brachial index in elderly Chinese[J].Atherosclerosis,2006,186(2):360-366.
[14]Meijer WT,Grobbee DE,Hunink MG,et al.Determinants of peripheral arterial disease in the elderly:the Rotterdam study[J].Arch Intern Med,2000,160(19):2934-2928.
[15]Weatherley BD,Nelson JJ,Heiss G,et al.The association of the anklebrachial index with incident coronary heart disease:the Atherosclerosis Risk in Communities(ARIC)study,1987-2001[J].BMC Cardiovasc Disord,2007,7:3.
[16]Guo X,Li J,Pang W,et al.Sensitivity and specificity of ankle-brachial index for detecting angiographic stenosis of peripheral arteries[J].Circ J,2008,72(4):605-610.
[17]Verberk WJ,Kollias A,Stergiou GS.Automated oscillometric determination of the ankle-brachial index:a systematic review and meta-analysis[J].Hypertens Res,2012,35(9):883-891.
[18]Clark CE,Campbell JL,Evans PH,et al.Prevalence and clinical implications of the inter-arm blood pressure difference:a systematic review[J].J Hum Hypertens,2006,20(12):923-931.
[19]Hirsch AT,Criqui MH,Treat-Jacobson D,et al.Peripheral arterial disease detection,awareness,and treatment in primary care[J].JAMA,2001,286(11):1317-1324.
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