收缩压与缺血性心血管病10年发病危险度对老年高血压人群全因死亡的影响
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摘要
目的探讨收缩压与缺血性心血管病(ICVD)10年发病危险度对无合并糖尿病和慢性肾脏病老年高血压人群全因死亡的影响。方法采取前瞻性队列研究方法,以首次参加2006-2007、2008-2009年开滦集团健康体检的6372例无合并糖尿病和慢性肾脏病老年高血压人群为观察对象。进行统一问卷调查、血液生化检查,以全因死亡为终点事件。依据观察对象收缩压值分为4组:收缩压<140 mm Hg(Q1组,n=703)、收缩压140～<150 mm Hg(Q2组,n=1931)、收缩压150～<160 mm Hg(Q3组,n=1472)和收缩压≥160 mm Hg(Q4组,n=2266)。用寿命表法计算各组累积全因死亡率,并采用Cox比例风险模型分析收缩压对全因死亡的影响。根据国人10年内ICVD发病危险简易评分方法,评估观察对象10年ICVD发病危险度,采用Cox比例风险模型探讨10年ICVD发病危险度对全因死亡的影响。结果随访(7.2±1.5)年,4组全因死亡例数和累积全因死亡率分别为128(18.2%)、323(16.7%)、264(17.9%)和458(20.2%)(χ~2=9.8,P=0.02)。以Q2组为对照,Cox比例风险模型分析显示,Q4组全因死亡风险比为1.23(95%CI 1.06～1.44,P<0.05);以Q1组为对照,Q2组10年内ICVD发病为很低危+低危、高危+很高危的全因死亡风险比分别为0.64(0.50～0.83)、1.48(1.05～2.10),P<0.05。校正混杂因素后,未服降压药者(n=3939)以及排除随访时间不足1年的观察对象24例后(n=6348),仅Q4组全因死亡风险增加。结论收缩压≥160 mm Hg无合并糖尿病和慢性肾脏病的老年高血压人群全因死亡风险增加23%。收缩压140～<150 mm Hg组10年ICVD发病低危及以下者全因死亡风险减少36%,高危及以上者全因死亡风险增加48%。
引文
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[15] 国家“十五”攻关“冠心病、脑卒中综合危险度评估及干预方案的研究”课题组. 国人缺血性心血管病发病危险的评估方法及简易评估工具的开发研究[J].中华心血管病杂志,2003,31(12):893-901.
[16] 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 中国心血管病预防指南[J]. 中华心血管病杂志,2011,39(1):3-22.
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[19] Wright JT Jr, Fine LJ, Lackland DT, et al. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view[J].Ann Intern Med,2014,160(7):499-503.
[20] JATOS study group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS)[J].Hypertens Res,2008,31(12):2115-2127.
[21] Ogihara T, Saruta T, Rakugi H, et al. Target blood pressure for treatment of isolated systolic hypertension in the elderly: valsartan in elderly isolated systolic hypertension study[J].Hypertension,2010,56(2):196-202.
[2] Kannel WB. The Framingham study[J].Br Med J,1976,2(6046):1255.
[3] Verdecchia P, Reboldi G. Risk and decision making in patients with hypertension[J].Lancet,2014,384(9943):562-564.
[4] Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older[J].N Engl J Med,2008,358(18):1887-98.
[5] Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the systolic hypertension in the elderly program (SHEP). SHEP cooperative research group[J].JAMA,1991,2655(24):3255-3264.
[6] Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The systolic hypertension in Europe (Syst-Eur) trial investigators[J].Lancet,1997,350(9080):757-764.
[7] National Clinical Guideline Centre (UK). Hypertension: the clinical management of primary hypertension in adults[M].London: Royal College of Physicians (UK),2011.
[8] Houle SK, Padwal R, Poirier L, et al. The 2015 Canadian hypertension education program(CHEP) guidelines for pharmacists: an update[J].Can Pharm J (Ott),2015,148(4):180-186.
[9] Mancia G, Fagard R, Narkiewiez K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology(ESC)[J].Eur Heart J,2013,34(28):2159-2219.
[10] 中国高血压防治指南修订委员会. 中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[11] Odutayo A, Rahimi K, Hsiao AJ, et al. Blood pressure targets and absolute cardiovascular risk[J].Hypertension,2015,66(2):280-285.
[12] Verdecchia P, Angeli F, Reboldi G. The SPRINT trial[J].J Am Soc Hypertens,2015,9(10):750-753.
[13] Wu S, Huang Z, Yang X, et al. Prevalence of ideal cardiovascular health and its relationship with the 4-year cardiovascular events in a Northern Chinese industrial city[J].Circ Cardiovasc Qual Outcomes,2012,5(4):487-493.
[14] 吴寿岭,王娜,赵海燕,等. 高敏C反应蛋白对高血压前期人群进展至高血压的预测价值[J].中华高血压杂志,2010,18(10):390-394.
[15] 国家“十五”攻关“冠心病、脑卒中综合危险度评估及干预方案的研究”课题组. 国人缺血性心血管病发病危险的评估方法及简易评估工具的开发研究[J].中华心血管病杂志,2003,31(12):893-901.
[16] 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 中国心血管病预防指南[J]. 中华心血管病杂志,2011,39(1):3-22.
[17] Navar-Boggan AM, Pencina MJ, Williams K, et al. Proportion of US adults potentially affected by the 2014 hypertension guideline[J].JAMA,2014,311(14):1424-1429.
[18] Blood pressure lowering treatment trialists' collaboration. Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data[J].Lancet,2014,384(9943):591-598.
[19] Wright JT Jr, Fine LJ, Lackland DT, et al. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view[J].Ann Intern Med,2014,160(7):499-503.
[20] JATOS study group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS)[J].Hypertens Res,2008,31(12):2115-2127.
[21] Ogihara T, Saruta T, Rakugi H, et al. Target blood pressure for treatment of isolated systolic hypertension in the elderly: valsartan in elderly isolated systolic hypertension study[J].Hypertension,2010,56(2):196-202.