Objective: To determine the relationship between pulse pressure and mortality from all the causes: CVD and CVA. Methods: The cohort consisted of the beneficiaries from Korea Medical Insurance Corporation (KMIC) aged 4...Objective: To determine the relationship between pulse pressure and mortality from all the causes: CVD and CVA. Methods: The cohort consisted of the beneficiaries from Korea Medical Insurance Corporation (KMIC) aged 40 and older who had taken health examination and completed the questionnaire inquiring of health habits and past medical history in 1992 or 1993. The number of cohort members was 698,796, and they were followed up from 1st January, 1994 until 31st December, 2000. The primary sources of the data used in this study were the death benefit record and health examination file of KMIC. In the case that the information about the cause of death was unknown in the death benefit record, it was checked from the death registry of National statistical Office and the inpatient data of KMIC. There were 37439 deaths during the follow-up period. Results: A linear relationship between pulse pressure and mortality from all the causes, cardiovascular disease and cerebrovascular disease, was determined in both genders, the whole population and age groups, in the hypertensive and normotensive (P<0. 01). Pulse pressure and mortality from all the causes, CVD and CVA increased (P<0.01). Pulse pressure was significantly associated with a relatively high risk of mortality from all the causes, CVD and CVA in the whole population, both genders, all age groups, the hypertensive and normotensive after adjusted to age, gender, body mass index, blood sugar, serum total cholesterol, AST, ALT, urine protein, urine glucose, alcohol drinking and cigarette smoking (P<0.01). Conclusion: Pulse pressure shows linear relationship with the mortality from all the causes, CVD and CVA. Pulse pressure appears to be a single measure of blood pressure in predicting mortality from all the causes, CVD and CVA, even in the hypertensive and normotensive.展开更多
Background:Arterial stiffening increases with age and blood pressure and is associated with cardiovascular disease(CVD),but the relationship between blood pressure lowering and arterial stiffening is still uncertain,e...Background:Arterial stiffening increases with age and blood pressure and is associated with cardiovascular disease(CVD),but the relationship between blood pressure lowering and arterial stiffening is still uncertain,especially in older people.This study aimed to evaluate the effect of intensive blood pressure treatment on the progression of arterial stiffness and risk of CVD in older patients with hypertension.Methods:The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients(STEP)trial was a multicenter,randomized,controlled trial performed at 42 clinical centers throughout China,and 8511 patients aged 60-80 years with essential hypertension were enrolled and randomly assigned to systolic blood pressure(SBP)target of 110 mmHg to<130 mmHg(intensive treatment)or 130 mmHg to<150 mmHg(standard treatment).Patients underwent repeated examinations of the brachial-ankle pulse wave velocity(baPWV)and ankle-brachial index(ABI)at baseline,and the arterial stiffness was evaluated at the 3-year follow-up.A total of 5339 patients who had twice repeated measurements were included in this study.Changes in arterial stiffness between the intensive and standard treatment groups were analyzed using a multivariate linear regression model.The Cox proportional hazard regression model was used to evaluate the effect of intensive treatment on primary CVD outcomes.Results:The changes in baPWV were 61.5 cm/s(95%confidence interval[CI]:49.8-73.2 cm/s)in the intensive treatment group and 98.4 cm/s(95%CI:86.7-110.1 cm/s)in the standard treatment group(P<0.001).Intensive treatment significantly delayed the progression of arterial stiffness,with an annual change of 23.1 cm·s^(-1)·year-1 vs.36.7 cm·s^(-1)·year^(-1)of baPWV in the intensive and standard treatment groups,respectively.During a median follow-up period of 3.36 years,primary CVD outcomes occurred in 77(2.9%)patients in the intensive treatment group compared with 93(3.5%)in the standard treatment group.Intensive treatment resulted in a significantly lower CVD risk in patients aged 70-80 years or with SBP<140 mmHg.Conclusion:Intensive blood pressure control with an SBP target of 110 mmHg to<130 mmHg could delay the progression of arterial stiffness and reduce the risk of CVD in older patients with hypertension.Clinical trial registration:http://www.clinicaltrials.gov;No.NCT03015311.展开更多
目的探讨维持性血液透析（MHD）患者脉压及脉压指数与心血管疾病（CVD）事件的相关性,观察脉压及脉压指数对CVD事件的预测价值。方法选择2012年5月—2013年5月在南京大学医学院附属鼓楼医院血液透析中心规律行MHD且病情稳定的患者86例,...目的探讨维持性血液透析（MHD）患者脉压及脉压指数与心血管疾病（CVD）事件的相关性,观察脉压及脉压指数对CVD事件的预测价值。方法选择2012年5月—2013年5月在南京大学医学院附属鼓楼医院血液透析中心规律行MHD且病情稳定的患者86例,测量血压,计算脉压及脉压指数。根据有无CVD事件分为CVD组和非CVD组,根据脉压分为：≤40 mm Hg,41-60 mm Hg,61-80 mm Hg,〉80 mm Hg;根据脉压指数分为：≤0.30,0.31-0.40,0.41-0.50,〉0.50。采用单因素和多因素Logistic回归法分析MHD患者发生CVD事件的影响因素。结果CVD组与非CVD组年龄、透析时间、收缩压、脉压、脉压指数、血糖、肾小球滤过率（eGFR）比较,差异均有统计学意义（P〈0.05）。不同脉压水平患者年龄、透析时间、收缩压、舒张压、脉压指数、eGFR及CVD事件发生率比较,差异均有统计学意义（P〈0.05）。不同脉压指数患者年龄、透析时间、收缩压、舒张压、脉压及CVD事件发生率比较,差异均有统计学意义（P〈0.05）。单因素Logistic回归分析结果显示：透析时间、脉压、脉压指数、血红蛋白与MHD患者CVD事件有关（P〈0.05）。多因素Logistic回归分析结果显示：透析时间、脉压、脉压指数、血红蛋白与MHD患者发生CVD事件有回归关系（P〈0.05）。结论透析时间长、脉压大、脉压指数大、贫血是MHD患者发生CVD事件的独立危险因素。临床上通过监测MHD患者脉压及脉压指数,早期、客观、准确地控制血压,可降低MHD患者CVD事件的发生率。展开更多
目的了解慢性腹膜透析病人的中心动脉脉压水平,分析其与心血管疾病(CVD)的关系。方法单中心横断面研究,共纳入234例维持性腹膜透析病人(均接受腹膜透析3月以上)。采用Sphygmo Cor无创主动脉脉波分析仪检测病人的中心动脉收缩压和舒张压...目的了解慢性腹膜透析病人的中心动脉脉压水平,分析其与心血管疾病(CVD)的关系。方法单中心横断面研究,共纳入234例维持性腹膜透析病人(均接受腹膜透析3月以上)。采用Sphygmo Cor无创主动脉脉波分析仪检测病人的中心动脉收缩压和舒张压,脉压=收缩压-舒张压。CVD定义为临床确诊的缺血性心脏病,心力衰竭,脑卒中和外周血管性疾病。结果有CVD的腹膜透析病人中心动脉脉压水平显著高于无CVD者(51.7±22.5 mm Hg vs 43.7±17.8 mm Hg,P=0.004),而肱动脉脉压在两组病人间无显著差异(66.7±25.3 mm Hg vs 61.9±19.7 mm Hg,P=0.106)。多因素Logistic回归分析后,中心动脉脉压仍独立与CVD相关(校正后OR 1.33,95%置信区间1.01-1.73,P=0.04)。结论高中心动脉脉压水平与慢性腹膜透析病人CVD相关。展开更多
文摘Objective: To determine the relationship between pulse pressure and mortality from all the causes: CVD and CVA. Methods: The cohort consisted of the beneficiaries from Korea Medical Insurance Corporation (KMIC) aged 40 and older who had taken health examination and completed the questionnaire inquiring of health habits and past medical history in 1992 or 1993. The number of cohort members was 698,796, and they were followed up from 1st January, 1994 until 31st December, 2000. The primary sources of the data used in this study were the death benefit record and health examination file of KMIC. In the case that the information about the cause of death was unknown in the death benefit record, it was checked from the death registry of National statistical Office and the inpatient data of KMIC. There were 37439 deaths during the follow-up period. Results: A linear relationship between pulse pressure and mortality from all the causes, cardiovascular disease and cerebrovascular disease, was determined in both genders, the whole population and age groups, in the hypertensive and normotensive (P<0. 01). Pulse pressure and mortality from all the causes, CVD and CVA increased (P<0.01). Pulse pressure was significantly associated with a relatively high risk of mortality from all the causes, CVD and CVA in the whole population, both genders, all age groups, the hypertensive and normotensive after adjusted to age, gender, body mass index, blood sugar, serum total cholesterol, AST, ALT, urine protein, urine glucose, alcohol drinking and cigarette smoking (P<0.01). Conclusion: Pulse pressure shows linear relationship with the mortality from all the causes, CVD and CVA. Pulse pressure appears to be a single measure of blood pressure in predicting mortality from all the causes, CVD and CVA, even in the hypertensive and normotensive.
基金supported by grants from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(Nos.2016-I2M-1-006 and 2021-I2M-1-011)
文摘Background:Arterial stiffening increases with age and blood pressure and is associated with cardiovascular disease(CVD),but the relationship between blood pressure lowering and arterial stiffening is still uncertain,especially in older people.This study aimed to evaluate the effect of intensive blood pressure treatment on the progression of arterial stiffness and risk of CVD in older patients with hypertension.Methods:The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients(STEP)trial was a multicenter,randomized,controlled trial performed at 42 clinical centers throughout China,and 8511 patients aged 60-80 years with essential hypertension were enrolled and randomly assigned to systolic blood pressure(SBP)target of 110 mmHg to<130 mmHg(intensive treatment)or 130 mmHg to<150 mmHg(standard treatment).Patients underwent repeated examinations of the brachial-ankle pulse wave velocity(baPWV)and ankle-brachial index(ABI)at baseline,and the arterial stiffness was evaluated at the 3-year follow-up.A total of 5339 patients who had twice repeated measurements were included in this study.Changes in arterial stiffness between the intensive and standard treatment groups were analyzed using a multivariate linear regression model.The Cox proportional hazard regression model was used to evaluate the effect of intensive treatment on primary CVD outcomes.Results:The changes in baPWV were 61.5 cm/s(95%confidence interval[CI]:49.8-73.2 cm/s)in the intensive treatment group and 98.4 cm/s(95%CI:86.7-110.1 cm/s)in the standard treatment group(P<0.001).Intensive treatment significantly delayed the progression of arterial stiffness,with an annual change of 23.1 cm·s^(-1)·year-1 vs.36.7 cm·s^(-1)·year^(-1)of baPWV in the intensive and standard treatment groups,respectively.During a median follow-up period of 3.36 years,primary CVD outcomes occurred in 77(2.9%)patients in the intensive treatment group compared with 93(3.5%)in the standard treatment group.Intensive treatment resulted in a significantly lower CVD risk in patients aged 70-80 years or with SBP<140 mmHg.Conclusion:Intensive blood pressure control with an SBP target of 110 mmHg to<130 mmHg could delay the progression of arterial stiffness and reduce the risk of CVD in older patients with hypertension.Clinical trial registration:http://www.clinicaltrials.gov;No.NCT03015311.
文摘目的探讨维持性血液透析（MHD）患者脉压及脉压指数与心血管疾病（CVD）事件的相关性,观察脉压及脉压指数对CVD事件的预测价值。方法选择2012年5月—2013年5月在南京大学医学院附属鼓楼医院血液透析中心规律行MHD且病情稳定的患者86例,测量血压,计算脉压及脉压指数。根据有无CVD事件分为CVD组和非CVD组,根据脉压分为：≤40 mm Hg,41-60 mm Hg,61-80 mm Hg,〉80 mm Hg;根据脉压指数分为：≤0.30,0.31-0.40,0.41-0.50,〉0.50。采用单因素和多因素Logistic回归法分析MHD患者发生CVD事件的影响因素。结果CVD组与非CVD组年龄、透析时间、收缩压、脉压、脉压指数、血糖、肾小球滤过率（eGFR）比较,差异均有统计学意义（P〈0.05）。不同脉压水平患者年龄、透析时间、收缩压、舒张压、脉压指数、eGFR及CVD事件发生率比较,差异均有统计学意义（P〈0.05）。不同脉压指数患者年龄、透析时间、收缩压、舒张压、脉压及CVD事件发生率比较,差异均有统计学意义（P〈0.05）。单因素Logistic回归分析结果显示：透析时间、脉压、脉压指数、血红蛋白与MHD患者CVD事件有关（P〈0.05）。多因素Logistic回归分析结果显示：透析时间、脉压、脉压指数、血红蛋白与MHD患者发生CVD事件有回归关系（P〈0.05）。结论透析时间长、脉压大、脉压指数大、贫血是MHD患者发生CVD事件的独立危险因素。临床上通过监测MHD患者脉压及脉压指数,早期、客观、准确地控制血压,可降低MHD患者CVD事件的发生率。
文摘目的了解慢性腹膜透析病人的中心动脉脉压水平,分析其与心血管疾病(CVD)的关系。方法单中心横断面研究,共纳入234例维持性腹膜透析病人(均接受腹膜透析3月以上)。采用Sphygmo Cor无创主动脉脉波分析仪检测病人的中心动脉收缩压和舒张压,脉压=收缩压-舒张压。CVD定义为临床确诊的缺血性心脏病,心力衰竭,脑卒中和外周血管性疾病。结果有CVD的腹膜透析病人中心动脉脉压水平显著高于无CVD者(51.7±22.5 mm Hg vs 43.7±17.8 mm Hg,P=0.004),而肱动脉脉压在两组病人间无显著差异(66.7±25.3 mm Hg vs 61.9±19.7 mm Hg,P=0.106)。多因素Logistic回归分析后,中心动脉脉压仍独立与CVD相关(校正后OR 1.33,95%置信区间1.01-1.73,P=0.04)。结论高中心动脉脉压水平与慢性腹膜透析病人CVD相关。
