中老年人血压变化轨迹与冠心病发病的关系
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摘要
目的探索血压随年龄变化的轨迹与冠心病发病的关系。方法以健康体检纵向数据管理队列为基础,应用群组化轨迹模型(GBTM)分别建立研究对象的收缩压和舒张压血压变化轨迹发展模型,依据其轨迹发展模型分别对收缩压和舒张压两个子队列人群进行轨迹分组;进而应用Cox回归模型分析子队列中不同轨迹变化组与冠心病发生的关联。结果收缩压和舒张压子队列分别包含1 215例和1 345例,随访期间两个子队列分别新发冠心病78例和86例。根据GBTM轨迹发展模型,可将收缩压子队列分为收缩压低水平上升组、中水平上升组和高水平快速上升组;舒张压子队列可分为舒张压低水平下降组和高水平下降组。对收缩压子队列和舒张压子队列分别进行Cox回归分析显示,调整可能的混杂因素(年龄、性别、收缩压、舒张压、吸烟、饮酒、体质量指数、空腹血糖、第1年体检、血脂异常等)后,收缩压子队列中,收缩压高水平快速上升组的冠心病发病风险是低水平上升组的冠心病发病风险的2.23倍(95%CI:1.13～4.40);舒张压子队列中,舒张压高水平下降组的冠心病发病风险是低水平下降组冠心病发病风险的0.96倍(95%CI:0.54～1.71)。进一步调整基线收缩压和舒张压水平后,收缩压子队列中,收缩压高水平快速上升组的冠心病发病风险是低水平上升组的冠心病发病风险的3.19倍(95%CI:1.31～7.80);舒张压子队列中,舒张压高水平下降组的冠心病发病风险是低水平下降组冠心病发病风险的1.04倍(95%CI:0.56～1.93)。而舒张压高水平下降组和低水平下降组组间冠心病发病水平差异无统计学意义(HR=1.03,95%CI:0.56～1.89)。结论血压水平随年龄的变化轨迹与冠心病发生有关,且不受包含基线血压水平在内的其他代谢因素的影响。
Objective To investigate the relationship between trajectory of blood pressure and the incidence of coronary heart disease(CHD). Methods Based on the longitudinal data from health management cohort, the trajectories of systolic blood pressure(SBP) and diastolic blood pressure(DBP) were constructed with the group-based trajectory model(GBTM). After that, the subjects were classified according to the trajectories of SBP and DBP. The association between CHD risk and trajectories of blood pressure was analyzed with Cox regression model. Results The subcohorts of SBP and DBP included 1 215 and 1 345 participants, respectively, with 78 and 86 new CHD cases during the follow-up. The subcohort of SBP was divided into low-growth, intermediate-growth and high-growth groups. The subcohort of DBP was divided into low-drop and high-drop groups. Cox regression was again used to investigate the association between the trajectories and CHD risk, and the confounding factors were adjusted, including age, gender, SBP, DBP, smoking, drinking, body mass index(BMI), fasting plasma glucose(FPG), first-year medical examination and dyslipidemia. For the SBP subcohort, the CHD risk of the high-growth group was 2.23 times of that of the low-growth group(95%CI: 1.13-4.40). For the DBP subcohort, the CHD risk of the high-drop group was 0.96 times of that of the low-drop group(95%CI: 0.54-1.71). When the baseline SBP and DBP levels were further adjusted, for the SBP subcohort, the CHD risk of the high-growth group was 3.19 times of that of the low-growth group(95%CI: 1.31-7.80); for the DBP subcohort, the CHD risk of the high-drop group was 1.04 times of that of the low-drop group(95%CI: 0.56-1.93). There was no statistically significant difference between the two DBP groups(HR=1.03, 95%CI: 0.56-1.89). Conclusion The longitudinal trajectory of blood pressure is related to CHD risk, and such relation is independent of other metabolic factors such as baseline blood pressure level.
Objective To investigate the relationship between trajectory of blood pressure and the incidence of coronary heart disease(CHD). Methods Based on the longitudinal data from health management cohort, the trajectories of systolic blood pressure(SBP) and diastolic blood pressure(DBP) were constructed with the group-based trajectory model(GBTM). After that, the subjects were classified according to the trajectories of SBP and DBP. The association between CHD risk and trajectories of blood pressure was analyzed with Cox regression model. Results The subcohorts of SBP and DBP included 1 215 and 1 345 participants, respectively, with 78 and 86 new CHD cases during the follow-up. The subcohort of SBP was divided into low-growth, intermediate-growth and high-growth groups. The subcohort of DBP was divided into low-drop and high-drop groups. Cox regression was again used to investigate the association between the trajectories and CHD risk, and the confounding factors were adjusted, including age, gender, SBP, DBP, smoking, drinking, body mass index(BMI), fasting plasma glucose(FPG), first-year medical examination and dyslipidemia. For the SBP subcohort, the CHD risk of the high-growth group was 2.23 times of that of the low-growth group(95%CI: 1.13-4.40). For the DBP subcohort, the CHD risk of the high-drop group was 0.96 times of that of the low-drop group(95%CI: 0.54-1.71). When the baseline SBP and DBP levels were further adjusted, for the SBP subcohort, the CHD risk of the high-growth group was 3.19 times of that of the low-growth group(95%CI: 1.31-7.80); for the DBP subcohort, the CHD risk of the high-drop group was 1.04 times of that of the low-drop group(95%CI: 0.56-1.93). There was no statistically significant difference between the two DBP groups(HR=1.03, 95%CI: 0.56-1.89). Conclusion The longitudinal trajectory of blood pressure is related to CHD risk, and such relation is independent of other metabolic factors such as baseline blood pressure level.
引文
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[9] 邓婷婷, 周素娴. 2型糖尿病合并高血压患者血脂、血糖代谢情况及其与高血压病程的关系[J]. 广东医学, 2014, 35(5): 722-724.
[10] 陈孟英, 张晶, 王伟, 等. 中老年单纯收缩期正常高值血压与冠心病的关系[J]. 天津医药, 2013, 41(8): 776-778.CHEN Mengying, ZHANG Jing, WANG Wei, et al. Relation of isolated high-normal blood pressure and coronary heart disease in middle-aged and elderly persons[J]. Tianjin Medical Journal, 2013, 41(8): 776-778.
[11] 罗富健, 张丁丁, 张云, 等. 高血压患者动态脉压及脉压指数与冠心病的关系[J]. 中国循环杂志, 2017, 32(5): 447-451.LUO Fujian, ZHANG Dingding, ZHANG Yun, et al. Relationship between ambulatory pulse pressure, pulse pressure index and coronary artery disease in hypertension patients[J]. Chinese Circulation Journal, 2017, 32(5): 447-451.
[12] Allen NB, Siddique J, Wilkins JT, et al. Blood pressure trajectories in early adulthood and subclinical atherosclerosis in middle age[J]. JAMA, 2014, 311(5): 490-497.
[13] Li JC, Tian J, Wu SL, et al. Effect of long-term systolic blood pressure trajectory on kidney damage in the diabetic population: a prospective study in a community-based Chinese cohort[J]. Chin Med J(Engl), 2018, 131(10): 1199-1205.
[14] Shen M, Tan H, Zhou S, et al. Trajectory of blood pressure change during pregnancy and the role of pre-gravid blood pressure: a functional data analysis approach[J]. Sci Rep, 2017, 7(1): 6227.
[15] Jones BL, Nagin DS. Advances in group-based trajectory modeling and an sas procedure for estimating them[J]. Sociological Methods & Research, 2007, 35(4): 542-571.
[16] Andruff H, Carraro N, Thompson A, et al. Latent class growth modelling: a tutorial[J]. Tutor Quant Methods Psychol, 2009, 5(1): 11-24.
[17] Nagin DS. Group-based trajectory modeling: an overview[J]. Ann Nutr Metab, 2014, 65(2-3): 205-210.
[18] Global Burden of Disease Cancer Collaboration. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability adjusted life-years for 32 cancer groups, 1990 to 2015 a systematic analysis for the global burden of disease study[J]. JAMA Oncol, 2017, 3(4): 524-548.
[19] Vasan RS, Larson MG, Leip EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease[J]. N Engl J Med, 2001, 345(18): 1291-1297.
[20] Franklin SS, Larson MG, Khan SA, et al. Does the relation of blood pressure to coronary heart disease risk change with aging: The framingham heart study[J]. Circulation, 2001, 103(9): 1245-1249.
[21] Lawes CM, Bennett DA, Lewington S, et al. Blood pressure and coronary heart disease: a review of the evidence[J]. Semin Vasc Med, 2002, 2(4): 355-368.
[22] Mahon SM, Rodgers A. The effects of blood pressure reduction in older patients: an overview of five randomized controlled trials in elderly hypertensives[J]. Clin Exp Hypertens, 1993, 15(6): 967-978.
[23] Collins R, Peto R, Macmahon S, et al. Blood pressure, stroke, and coronary heart disease. part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context[J]. Lancet, 2000, 335(8693): 827-838.
[24] 李晓妹, 刘福元. H 型高血压合并冠心病患者血清 Hcy 含量与冠状动脉粥样硬化病变程度的相关性[J].海南医学院学报, 2017, 23(3): 320-322.LI Xiaomei, LIU Fuyuan. Correlation between serum Hcy content and coronary atherosclerosis severity in patients with H-type hypertension and coronary heart disease[J]. Journal of Hainan Medical University, 2017, 23(3): 320-322.
[25] 刘强, 杨小梅, 韩乾国. 血浆同型半胱氨酸水平与冠心病患者中心动脉压及冠状动脉病变程度的相关性研究[J].实用心脑肺血管病杂志, 2015, 23(8): 18-21.LIU Qiang, YANG Xiaomei, HAN Qianguo. Correlations between plasma homocysteine level and central arterial pressure, severity of coronary artery disease of patients with coronary heart disease[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2015, 23(8): 18-21.
[26] 张林洁. 动态动脉硬化指数的临床意义[J]. 中国美容医学, 2012, 21(10): 136-137.
[2] 王勤, 徐莉. 综合护理干预措施对于改善冠心病患者生活质量的效果分析[J]. 贵州医药, 2017, 41(3): 331-333.
[3] Kannel WB. Blood pressure as a cardiovascular risk factor: prevention and treatment[J]. JAMA, 1996, 275(20): 1571-1576.
[4] Thorogood M, Connor MD, Lewando-Hundt G, et al. Secondary prevention of stroke--results from the Southern Africa Stroke Prevention Initiative(SASPI) study[J]. Bull World Health Organ, 2004, 82(7): 503-508.
[5] Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data[J]. Lancet, 2005, 365(9455): 217-223.
[6] Lesevic H, Schunkert H. Hypertension and coronary heart disease[J]. MMW Fortschr Med, 2013, 155(13): 62-64.
[7] Abell JG, Kivim?ki M, Dugravot A, et al. Association between systolic blood pressure and dementia in the Whitehall II cohort study: role of age, duration, and threshold used to define hypertension[J]. Eur Heart J, 2018, 39(33): 3119-3125.
[8] 吕海权, 雷敏, 陆敏, 等. H型高血压对冠心病患者预后的影响[J].中国动脉硬化杂志, 2016, 24(4): 396-400.LV Haiquan, LEI Min, LU Min, et al. Effect of H-type hypertension on prognosis of patients with coronary heart disease[J]. Chinese Journal of Arteriosclerosis, 2016, 24(4): 396-400.
[9] 邓婷婷, 周素娴. 2型糖尿病合并高血压患者血脂、血糖代谢情况及其与高血压病程的关系[J]. 广东医学, 2014, 35(5): 722-724.
[10] 陈孟英, 张晶, 王伟, 等. 中老年单纯收缩期正常高值血压与冠心病的关系[J]. 天津医药, 2013, 41(8): 776-778.CHEN Mengying, ZHANG Jing, WANG Wei, et al. Relation of isolated high-normal blood pressure and coronary heart disease in middle-aged and elderly persons[J]. Tianjin Medical Journal, 2013, 41(8): 776-778.
[11] 罗富健, 张丁丁, 张云, 等. 高血压患者动态脉压及脉压指数与冠心病的关系[J]. 中国循环杂志, 2017, 32(5): 447-451.LUO Fujian, ZHANG Dingding, ZHANG Yun, et al. Relationship between ambulatory pulse pressure, pulse pressure index and coronary artery disease in hypertension patients[J]. Chinese Circulation Journal, 2017, 32(5): 447-451.
[12] Allen NB, Siddique J, Wilkins JT, et al. Blood pressure trajectories in early adulthood and subclinical atherosclerosis in middle age[J]. JAMA, 2014, 311(5): 490-497.
[13] Li JC, Tian J, Wu SL, et al. Effect of long-term systolic blood pressure trajectory on kidney damage in the diabetic population: a prospective study in a community-based Chinese cohort[J]. Chin Med J(Engl), 2018, 131(10): 1199-1205.
[14] Shen M, Tan H, Zhou S, et al. Trajectory of blood pressure change during pregnancy and the role of pre-gravid blood pressure: a functional data analysis approach[J]. Sci Rep, 2017, 7(1): 6227.
[15] Jones BL, Nagin DS. Advances in group-based trajectory modeling and an sas procedure for estimating them[J]. Sociological Methods & Research, 2007, 35(4): 542-571.
[16] Andruff H, Carraro N, Thompson A, et al. Latent class growth modelling: a tutorial[J]. Tutor Quant Methods Psychol, 2009, 5(1): 11-24.
[17] Nagin DS. Group-based trajectory modeling: an overview[J]. Ann Nutr Metab, 2014, 65(2-3): 205-210.
[18] Global Burden of Disease Cancer Collaboration. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability adjusted life-years for 32 cancer groups, 1990 to 2015 a systematic analysis for the global burden of disease study[J]. JAMA Oncol, 2017, 3(4): 524-548.
[19] Vasan RS, Larson MG, Leip EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease[J]. N Engl J Med, 2001, 345(18): 1291-1297.
[20] Franklin SS, Larson MG, Khan SA, et al. Does the relation of blood pressure to coronary heart disease risk change with aging: The framingham heart study[J]. Circulation, 2001, 103(9): 1245-1249.
[21] Lawes CM, Bennett DA, Lewington S, et al. Blood pressure and coronary heart disease: a review of the evidence[J]. Semin Vasc Med, 2002, 2(4): 355-368.
[22] Mahon SM, Rodgers A. The effects of blood pressure reduction in older patients: an overview of five randomized controlled trials in elderly hypertensives[J]. Clin Exp Hypertens, 1993, 15(6): 967-978.
[23] Collins R, Peto R, Macmahon S, et al. Blood pressure, stroke, and coronary heart disease. part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context[J]. Lancet, 2000, 335(8693): 827-838.
[24] 李晓妹, 刘福元. H 型高血压合并冠心病患者血清 Hcy 含量与冠状动脉粥样硬化病变程度的相关性[J].海南医学院学报, 2017, 23(3): 320-322.LI Xiaomei, LIU Fuyuan. Correlation between serum Hcy content and coronary atherosclerosis severity in patients with H-type hypertension and coronary heart disease[J]. Journal of Hainan Medical University, 2017, 23(3): 320-322.
[25] 刘强, 杨小梅, 韩乾国. 血浆同型半胱氨酸水平与冠心病患者中心动脉压及冠状动脉病变程度的相关性研究[J].实用心脑肺血管病杂志, 2015, 23(8): 18-21.LIU Qiang, YANG Xiaomei, HAN Qianguo. Correlations between plasma homocysteine level and central arterial pressure, severity of coronary artery disease of patients with coronary heart disease[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2015, 23(8): 18-21.
[26] 张林洁. 动态动脉硬化指数的临床意义[J]. 中国美容医学, 2012, 21(10): 136-137.