测量四肢血压的预测价值

测量 四肢 血压 的预测价值上海交通大学医学院附属瑞金医院上海市高血压研究所王继光 第1 页/ 共26 页The Shanghai Cardiovascular Health Study (SCHS) n The JingNing population studyn The QingPu population studyn The QingPu study in the elderly n The NingBo study in the workplace setting 第2 页/ 共26 页baPWV and mortality第3 页/ 共26 页SCHS: Objective To investigate the prognostic significance of four-limb blood pressure for total and CV mortality in an elderly (60 years) Chinese population. Sheng CS, et al. Hypertension 2013; 61:1155-60.第4 页/ 共26 页SCHS: Study population n We invited all residents of 60 years or older from villages and communities of a town in the suburb of Shanghai, 30 km from the city centre, to participate in cardiovascular health examinations. n Our study started in 2006 on subjects in the age range from 60 to 69 years, and then in 2007 on subjects of 70 years or older. These subjects were followed up for events, and repeated examinations were performed once every 2 years. Sheng CS, et al. Hypertension 2013; 61:1155-60.第5 页/ 共26 页OMRON VP-1000SCHS: Four-limb BP and pulse wave velocity1. Four-limb BP for the calculation of BP differences and ratios, eg, ankle-brachial index (ABI)2. Pulse wave velocity (brachial-ankle)第6 页/ 共26 页四肢血 压u 上臂血 压 u 踝臂指数 (ABI) = 较 低一 侧 踝部血 压 /较 高一 侧 肱 动 脉血压u 双臂 间 血 压 差 值 = 左臂血压 右臂血压 u 双踝 间 血 压 差 值 = 左踝血压 右踝血压 Sheng CS, et al. Hypertension 2013; 61:1155-60.第7 页/ 共26 页 Means and proportions were compared with the student t-test and Fishers exact test, respectively. Multiple Cox regression analyses were used to determine the hazard ratios of total and CV mortality with 4-limb BP ratios and difference, while controlling for covariates. The log-rank test was used to compare the cumulative incidence of mortality between groups, with Kaplan-Meier survival curve to show the time to deaths. The C-statistic analysis was performed to examine the incremental prognostic value for mortality.Statistical methods Sheng CS, et al. Hypertension 2013; 61:1155-60.第8 页/ 共26 页研究结果第9 页/ 共26 页General outline of the study Number of participants: 3133 Median follow-up time: 4.0 years Cumulative number of person-years: 12,500 Number of total deaths: 203 Number of CV deaths: 93 (CHD, CHF and stroke)Sheng CS, et al. Hypertension 2013; 61:1155-60.第10 页/ 共26 页基线特征 (1)Characteristic Men (n=1383) Women (n=1750) P valueAge, years 68.57.2 69.37.5 0.005Body mass index, kg/m2 23.43.4 23.83.7 0.002Systolic pressure, mm Hg 136.518.6 141.320.2 0.9All mortalityCV mortalityNo. of event / No. on riskRate per 1000 p-yrs2.02 (1.24-3.30)1.70 (0.86-3.39)* Adjusted for age, sex, body mass index, current smoking, current alcohol intake, systolic and diastolic blood pressure, hypertension treatment, diabetes mellitus, and serum total cholesterol.ABI0.95 ABI0.95All mortalityCV mortality39/175 55.822/175 31.5164/2958 13.971/2958 6.02.23 (1.52-3.26)2.12 (1.24-3.64)Sheng CS, et al. Hypertension 2013; 61:1155-60.第16 页/ 共26 页双臂 间 血 压 差 Total mortality CV mortalityHR (95%CI)* P value HR (95%CI)* P valueSystolic (+3.76 mmHg) 1.16 (1.04-1.30) 0.01 1.18 (1.01-1.40) 0.04Diastolic (+3.07 mmHg) 1.17 (1.05-1.31) 0.005 1.23 (1.06-1.44) 0.006* The analyses were adjusted for age, sex, body mass index, current smoking, current alcohol intake, use of antihypertensive drugs, diabetes mellitus, serum total cholesterol, and arm systolic and diastolic blood pressure.双臂间血压差值预测价值Sheng CS, et al. Hypertension 2013; 61:1155-60.第17 页/ 共26 页双臂间血压差值预测价值Total mortalitySheng CS, et al. Hypertension 2013; 61:1155-60.第18 页/ 共26 页Event Relative risk (95% CI)0.5 1 2 4 821/199 25.59/199 10.9182/2934 15.5 84/2934 7.210 mmHgAll mortalityCV mortalityNo. of event / No. on riskRate per 1000 p-yrs1.72 (1.06-2.80)1.45 (0.70-3.00)* Adjusted for age, sex, body mass index, current smoking, current alcohol intake, systolic and diastolic blood pressure, hypertension treatment, diabetes mellitus, and serum total cholesterol.All mortalityCV mortality9/55 40.34/55 17.9194/3078 15.889/3078 7.22.47 (1.24-4.93)2.11 (0.75-5.96)双臂间血压差值预测价值0.9)Total mortality CV mortalityHR (95% CI)* P value HR (95% CI)* P valueInter-arm BP difference, mm Hg 10 vs 10 1.44 (0.78-2.65) 0.24 1.29 (0.50-3.31) 0.5915 vs 15 2.04 (0.74-5.65) 0.17 2.36 (0.54-10.29) 0.25Inter-ankle BP difference, mm Hg10 vs 10 1.63 (1.17-2.27) 0.004 1.70 (1.05-2.77) 0.0315 vs 15 1.82 (1.18-2.80) 0.006 1.86 (1.02-3.40) 0.04Sheng CS, et al. Hypertension 2013; 61:1155-60.第23 页/ 共26 页Total mortality CV mortalityc statistic P value* c statistic P value*ABI0.90 0.54 (0.52-0.57) - 0.56 (0.52-0.59) -+Inter-arm BP difference 15 mmHg 0.55 (0.52-0.57) 0.46 0.56 (0.53-0.60) 0.50+Inter-ankle BP difference 15 mmHg 0.59 (0.56-0.62) 0.0001 0.62 (0.57-0.67) 0.0001+Inter-arm BP difference 15 mmHg and Inter-ankle BP difference 15 mmHg0.60 (0.57-0.62) 0.00010.63 (0.58-0.67) 0.0001Incremental prognostic value*For the comparison with the c