血压不同控制水平对老年男性高血压患者心血管事件的影响

Effect of blood pressure control on cardiovascular events in elderly male hypertensive patients

目的了解老年男性高血压降压过程中有无"J"型曲线现象,探讨老年高血压降压的合适范围。方法选择老年男性高血压患者846例,根据收缩压和舒张压水平分别分为:≤120 mm Hg(1mm Hg=0.133 kPa(S1组)213例,1 21～130 mm Hg(S2组)21 5例,131～140 mm Hg(S3组)219例,1 41～150 mm Hg(S4组)121例,>1 50mm Hg(S5组)78例;≤60 mm Hg(D1组)107例,61～70 mm Hg(D2组)258例,71～80 mm Hg(D3组)339例,81～90 mm Hg(D4组)125例,>90 mm Hg(D5组)17例。分析不同血压水平与心血管事件的关系。结果 S5组心血管死亡、致死脑卒中、非致死心肌梗死(MI)和脑卒中发生率最高,S4组心血管死亡、冠心病死亡、致死脑卒中和非致死MI发生率最低,组间比较差异显著(P<0.05,P<0.01)。D5组全因死亡、心血管死亡、冠心病死亡、致死脑梗死、非致死MI和脑卒中发生率最高,D4组全因死亡、心血管死亡、冠心病死亡发生率最低,组间比较差异显著(P<0.05)。结论老年男性高血压降压过程中可见"J"型曲线,降压合适范围为140～150/80～90 mm Hg。

Objective To study the optimal blood pressure of elderly male hypertensive patients by observing whether there is aJ-shaped curve＇during antihypertensive treatment. Methods Eight hundred and forty-six elderly male hypertensive patients were divided into≤120 mm Hg （S1 group,n：213）,121--130 mm Hg （S2 group,n=215）,131--140 mm Hg （S3 group,n=219）, 141--150 mm Hg （S4 group,n=121）,〉150 mm Hg （S5 group,n：78）according to their SBP, and into 460 mm Hg （D1 group,n：107）,61--70 mm Hg （D2 group,n：258）,71--80 mm Hg （D3 group,n：339）,81--90 mm Hg （D4 group,n：125）,and 〉90 mm Hg （D5 group,n：lT） ac- cording to their DBP. Relation of blood pressure control with cardiovascular events was analyzed. Results The incidence of death due to cardiovascular events, fatal cerebral stroke, nonfatal myo- cardial infarction（MI） and cerebral stroke was the highest in $5 group while the incidence of death due to cardiovascular events,CHD,fatal cerebral stroke and nonfatal MI was the lowest in $4 group（P〈0.05,P〈0.01）. The incidence of death due to all causes,cardiovascular events, CHD,fatal cerebral stroke,nonfatal MI and cerebral stroke was the highest in D5 group while the incidence of death due to all causes, cardiovascular events and CHD was the lowest in D4 group （P〈0.05）. Conclusion ＂J-shaped curve＂ can be observed in elderly male hypertensive patients during antihypertensive treatment. Their optimal blood pressure is 140--150/80--90 mm Hg.