老年人群血压水平与日常活动能力失能风险的前瞻性队列研究

Association between blood pressure and activities of daily living disability among old population:a prospective cohort study

目的探讨老年人群血压与日常活动能力失能风险的相关性。方法前瞻性队列研究中国老年健康影响因素跟踪调查(Chinese Longitudinal and Health Longevity Study,CLHLS)2008~2018年随访数据,随访结局为日常活动能力(Activities of daily living,ADL)失能。结果共纳入研究对象2172名,其中男性1032名(47.5%),共发生ADL失能466例,累计发生率为21.5%。拟合Cox比例风险模型,逐步调整年龄、性别、民族、文化程度、吸烟、饮酒和BMI指数后,收缩压和脉压差升高1 mmHg,老年人群10年后ADL失能的发生风险均增加8%(P<0.05),舒张压升高与ADL失能的发生风险未发现统计学关联;以非高血压人群为参照,老年高血压人群的ADL失能发生风险增加28.4%(HR=1.284,95%CI:1.025-1.609);以正常血压老人为参照,2级和3级高血压人群发生ADL失能的风险分别增加388.1%(HR=4.881,95%CI:1.194-2.962)和465.5%(HR=5.655,95%CI:1.233~5.720);以非单纯性收缩期高血压人群为对照组,单纯性收缩期高血压人群发生ADL失能的风险增加26.9%(HR=1.269,95%CI:1.004~1.604)。男性和女性老年人群血压与ADL失能的关联性不同。结论收缩压、脉压差及不同高血压指标的升高均与ADL失能风险升高相关,应加强老年人群收缩压和脉压差防控与管理。

Objective To explore the association between different blood pressure indicators and ADL disability among old adults in China.Methods This is a prospective cohort study using Chinese Longitudinal and Health Longevity Study(CLHLS).Blood pressure indicators were measured in 2008 and follow-up study on ADL disability was conducted in 2018.The association between blood pressure and ADL disability was analyzed by Cox proportional hazard model.Results A total of 2172 old adults were included,including 1032 males,accounting for 47.5%.Over 10 years’ follow-up,466 old adults were identified as ADL disability among 2172 individuals who had normal ADL at baseline,with cumulative incidence of 21.5%.After adjustment of age,gender,BMI,nationality,educational level,smoking and drinking,elevated systolic blood pressure and pulse pressure significantly increased the incidence of ADL disability(P < 0.05);no significant association between the increased diastolic blood pressure and the incidence of ADL disability was found;compared with non-dyslipidemia group,HR(95% CI)of ADL disability was 1.284(1.025-1.609);compared with normal blood pressure group,HR(95% CI)of ADL disability for population with grade 2 and 3 hypertension were 4.881(1.194-2.962)and 5.655(1.233-5.720),respectively;compared with non-isolated systolic hypertension group,HR(95% CI)of ADL disability for isolated systolic hypertension group was 1.269(1.004-1.604).Gender differences in the association between blood pressure and ADL disability in the old adults were significantly existed.Conclusion Increased blood pressure indicators might increase the incidence of ADL disability.The prevention and control of systolic blood pressure and pulse pressure difference in the elderly should be strengthened.