脉压对中老年人急性心肌梗死预测价值的前瞻性研究

A cohort study on the predictive value of pulse pressure to acute myocardial infarction in middle-aged and senile population

目的 :探讨中老年人脉压 (PP)水平对急性心肌梗死 (AMI)发病的预测价值。方法 :于 1991年 8月对山东省中老年人群进行心血管病危险因素的基线调查 ,对AMI事件的发病进行随访登记。到 1999年底 ,110 0 8例中老年人共发生AMI 117例 ,应用Cox回归分析PP对AMI的预测价值。结果 :AMI患者的PP均值[5 8.4 2mmHg(1mmHg =0 .133kPa) ]明显高于非AMI者的PP均值 [(5 0 .0 4mmHg) ,(P <0 .0 1) ]。校正其他危险因素后 ,老年人PP每增加 10mmHg ,AMI危险增加 2 9.8% ;在每一舒张压水平 ,PP每增加 10mmHg ,AMI危险增加 2 5 .7% ,但不独立于收缩压。中年人PP不是AMI的预测指标 ,而平均动脉压和舒张压则是。老年人PP≥ 5 0mmHg者患AMI危险为PP 4 0～ 4 9mmHg者的3.2～ 3.3倍 ,校正舒张压后依然如此 ;PP <4 0mmHg者AMI危险有增高的趋势 ,但差异无统计学意义。结论 :①PP为老年人AMI新的预测因子 ,但不独立于收缩压。中年人AMI危险主要与平均动脉压和舒张压相关。②老年人PP≥ 5 0mmHg应作为AMI危险的界值 ,且PP 4 0～ 4 9mmHg时AMI的风险最小。

Objective:To explore the predictive value of pulse pressure (PP) to the incidence of acute myocardial infarction (AMI) in middle-aged and senile population. Method:The baseline survey of middle-aged and senile population of Shandong province was carried out in the year 1991.Totally 117 AMI event occurred among the 11 008 subjects after 8 years follow-up, the correlation between PP and AMI was analyzed by using Cox regression model. Result:The mean PP was significantly higher in total AMI population than in normal population(P< 0.001).In senile population, for each 10 mmHg increase in PP, there was an independent 29.8% increase in the risk of AMI,and at every diastolic blood pressure (DBP) level, the relative risk was 25.7%. However, in middle-aged population, PP was not the predictive marker, while mean blood pressure (MAP) or DBP was. In senile population, in comparison with median tertile of pulse pressure (40 to 49 mm Hg), subjects with higher pulse pressure(PP ≥50 mm Hg) had adjusted relative risks of 3.2- 3.3 (P< 0.05) for AMI, compared with median tertile of pulse pressure (40 to 49 mm Hg) . Conclusion:①In senile population, PP is a risk factor of AMI, while in middle-aged population, AMI risk is mainly related to MAP and DBP. ②In senile population, PP≥50 mm Hg should be regard as the marker for risk of AMI.