健康中老年人血压与踝臂脉搏波传导速度

Association Between Blood Pressure and Brachial-ankle Pulse Wave Velocity

目的研究相对健康中老年人血压与踝臂脉搏波传导速度(baPWV)的相关性。方法用单纯随机法收集1914名年龄≥50岁、自报未患有脑卒中、心肌梗死、肺心病及恶性肿瘤等重大慢性疾病的相对健康中老年进行横断面研究,采集个人资料,测定血压,血清空腹血糖和血脂及应用脉搏波速度自动测量系统测定baPWV,并根据baPWV结果将受检者分为两组进行分析,baPWV<1400 cm/s组(n=679)和baPWV≥1400 cm/s组(n=1235)。结果①baPWV≥1400 cm/s组中高血压患者的比例明显高于baPWV<1400 cm/s组(50.8%比12.3%,P<0.01);②血压水平三分位数分组后,各组baPWV对比结果显示,在调整年龄和性别因素后,平均baPWV水平随收缩压、舒张压及脉压水平升高明显升高(均P<0.01);③经调整多种潜在混杂因素后,相对于血压理想组,正常血压组和高血压组baPWV(≥1400 cm/s)的比值比分别为3.6,95%CI(2.8～4.7)和10.0,95%CI(7.5～13.4)(P<0.01),并且随着收缩压,舒张压和脉压逐渐升高,baPWV的比值比也逐渐加大(P<0.01);④多元线性逐步回归分析显示,收缩压的标准化β值最高,表明收缩压与baPWV的关系最明显。结论血压的增高与脉搏波传导速度加快密切相关,降低中老年人的血压(尤其是收缩压),使血压保持在理想血压范围内,对减缓动脉硬化的发展进程有重要的临床意义。

Objectives To examine the association between blood pressure and arterial stiffness assessed by brachial-ankle pulse wave velocity （baPWV） among relatively healthy older Chinese people without stroke, myocardial infarction, pulmonary heart disease and malignant tumor. Methods One thousand and nine hundred fourteen apparently ＂healthy＂ older subjects aged ≥50 years enrolled from the Guangzhou Biobank Cohort Study （GBCS） for this cross-section study. Information on personal history, blood pressure, fasting plasma glucose and lipids were collected; baPWV was measured using an automated recording device. Subjects were classified into two groups according to the baPWV level（baPWV〈1400 cm/s, n= 679 and baPWV≥1400 cm/s, n= 1235）. Results ① In subjects with baPWV≥1400 cm/s, the percentage with hypertension was significantly higher than those with baPWV〈1400 cm/s （50.80/00 vs 12.3%, P〈0.01）.② After adjusting for age and sex, mean baPWV increased from the lowest tertiles of systolic blood pressure （SBP）, DBP, and PP to the highest tertiles （all P〈0.01）. ③ After adjusting for multiple potential confounders, the odds ratios （95% CI） for higher baPWV （≥1400 cm/s） in the normal blood pressure and hypertension group were 3.6 （2.8--4.7） and 10.0 （7.5--13.4） ,respectively （P〈0.01） compared to those with optimal blood pressure. The odds ratios increased with increasing SBP, DBP, and PP （all P〈0.01）. ④ Multiple linear stepwise regression analys revealed that SBP was the most important determinant for baPWV. Conclusion Blood pressure is closely and positively associated with pulse wave velocity, suggesting that lower blood pressure, especially keeping blood pressure with in optimal range in the elderly might confer to slowing down the development and progression of vascular stiffness.