1、测量测量四肢四肢血压血压的预测价值的预测价值上海交通大学医学院附属瑞金医院上海交通大学医学院附属瑞金医院上海市高血压研究所上海市高血压研究所王继光王继光 The Shanghai Cardiovascular Health Study(SCHS)nThe JingNing population studynThe QingPu population studynThe QingPu study in the elderly nThe NingBo study in the workplace setting baPWV and mortalitySCHS:Objective To invest
2、igate 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.SCHS:Study population n We invited all residents of 60 years or older from villages and communities of a town in the suburb o
3、f 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 performe
4、d once every 2 years.Sheng CS,et al.Hypertension 2013;61:1155-60.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)四肢血压四肢血压u 上臂血压上臂血压 u 踝臂指数踝臂指数 (ABI)(ABI)=较低一侧踝部血压较低一
5、侧踝部血压/较高一侧肱动脉血压较高一侧肱动脉血压u 双臂间血压差值双臂间血压差值 =左臂血压左臂血压 右臂血压右臂血压 u 双踝间血压差值双踝间血压差值 =左踝血压左踝血压 右踝血压右踝血压 Sheng CS,et al.Hypertension 2013;61:1155-60.Means and proportions were compared with the student t-test and Fishers exact test,respectively.Multiple Cox regression analyses were used to determine the haza
6、rd 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 e
7、xamine the incremental prognostic value for mortality.Statistical methods Sheng CS,et al.Hypertension 2013;61:1155-60.研究结果研究结果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 deat
8、hs:93(CHD,CHF and stroke)Sheng CS,et al.Hypertension 2013;61:1155-60.基线特征基线特征(1)(1)CharacteristicMen (n=1383)Women(n=1750)P valueAge,yearsAge,years68.57.269.37.50.005Body mass index,kg/mBody mass index,kg/m2 223.43.423.83.70.002Systolic Systolic pressure,mm Hgpressure,mm Hg136.518.6141.320.20.0001Di
9、astolic Diastolic pressure pressure,mm Hg,mm Hg81.510.179.510.10.0001Sheng CS,et al.Hypertension 2013;61:1155-60.基线特征基线特征(2)(2)CharacteristicMen (n=1383)Women(n=1750)P valueABI ABI 1.100.101.070.080.0001 0.90,n(%)0.90,n(%)40(2.9)43(2.5)0.45Inter-arm BP Inter-arm BP difference,mmHgdifference,mmHg3.71
10、3.673.893.840.18 15 mm Hg,n(%)15 mm Hg,n(%)18(1.3)37(2.1)0.09 10mm Hg,n(%)10mm Hg,n(%)76(5.6)123(7.0)0.06Inter-ankle BP Inter-ankle BP difference,mmHgdifference,mmHg6.546.726.266.150.23 15 mm Hg,n(%)15 mm Hg,n(%)113(8.2)134(7.7)0.60 10 mm Hg,n(%)10 mm Hg,n(%)284(20.5)361(20.6)0.95Sheng CS,et al.Hype
11、rtension 2013;61:1155-60.Total mortality CV mortalityHR(95%CI)*P valueHR(95%CI)*P valueSystolic BP,+1SD1.04(0.80-1.25)0.711.11(0.84-1.48)0.46Diastolic BP,+1SD0.81(0.65-1.01)0.060.78(0.57-1.08)0.13Pulse pressure,+1SD1.12(0.94-1.33)0.201.17(0.91-1.51)0.21Mean pressure,+1SD0.80(0.65-0.99)0.040.80(0.60-
12、1.08)0.14单侧上臂血压预测价值单侧上臂血压预测价值*The analyses were adjusted for age,sex,body mass index,current smoking,current alcohol intake,use of antihypertensive drugs,diabetes mellitus,and serum total cholesterol.Sheng CS,et al.Hypertension 2013;61:1155-60.ABI(-1 SD)Total mortalityCV mortalityHR(95%CI)*P valueHR
13、(95%CI)*P valueSystolic BP(-0.09)1.22(1.10-1.36)0.00031.24(1.07-1.44)0.005Diastolic BP(-0.07)1.23(1.11-1.35)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 dia
14、stolic blood pressure,hypertension treatment,diabetes mellitus,and serum total cholesterol.ABI0.95ABI0.95All mortalityCV mortality 39/175 55.8 22/175 31.5 164/2958 13.9 71/2958 6.0 2.23(1.52-3.26)2.12(1.24-3.64)Sheng CS,et al.Hypertension 2013;61:1155-60.双臂间血压差双臂间血压差Total mortality CV mortalityHR(95
15、%CI)*P valueHR(95%CI)*P valueSystolic(+3.76 mmHg)1.16(1.04-1.30)0.011.18(1.01-1.40)0.04Diastolic(+3.07 mmHg)1.17(1.05-1.31)0.0051.23(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 tot
16、al cholesterol,and arm systolic and diastolic blood pressure.双臂间血压差值预测价值双臂间血压差值预测价值Sheng CS,et al.Hypertension 2013;61:1155-60.双臂间血压差值预测价值双臂间血压差值预测价值Total mortalitySheng CS,et al.Hypertension 2013;61:1155-60.EventRelative risk(95%CI)0.5 1248 21/199 25.5 9/199 10.9 182/2934 15.5 84/2934 7.210 mmHg Al
17、l mortality CV 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 mortality CV mort
18、ality 9/55 40.3 4/55 17.9 194/3078 15.8 89/3078 7.2 2.47(1.24-4.93)2.11(0.75-5.96)双臂间血压差值预测价值双臂间血压差值预测价值10 mmHg15 mmHg15mmHgSheng CS,et al.Hypertension 2013;61:1155-60.双双踝间血压差踝间血压差Total mortality CV mortalityHR(95%CI)*P valueHR(95%CI)*P valueSystolic(+6.40 mmHg)1.15(1.05-1.27)0.0041.20(1.06-1.36)0.0
19、04Diastolic(+3.70 mmHg)1.15(1.06-1.24)0.00091.17(1.06-1.30)0.002*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.双踝间血压差值预测价值双踝间血压差值预测价值S
20、heng CS,et al.Hypertension 2013;61:1155-60.双踝间血压差值预测价值双踝间血压差值预测价值Total mortalitySheng CS,et al.Hypertension 2013;61:1155-60.EventRelative risk(95%CI)0.5 1248 73/645 28.1 42/645 16.2 130/2488 13.1 51/2488 5.110 mmHgAll mortalityCV mortalityNo.of event/No.on riskRate per 1000 p-yrs1.52(1.16-2.06)1.75(
21、1.12-2.74)*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 mortality 40/244 41.8 26/244 27.5 163/2889 14.1 67/2889 5.8 1.63(1.12-2.38)1.89(1.13-3.18)
22、双踝间血压差值预测价值双踝间血压差值预测价值10 mmHg15 mmHg0.9)Total mortality CV mortalityHR(95%CI)*P valueHR(95%CI)*P valueInter-arm BP difference,mm Hg 10 vs 101.44(0.78-2.65)0.241.29(0.50-3.31)0.5915 vs 152.04(0.74-5.65)0.172.36(0.54-10.29)0.25Inter-ankle BP difference,mm Hg10 vs 101.63(1.17-2.27)0.0041.70(1.05-2.77)0
23、.0315 vs 151.82(1.18-2.80)0.0061.86(1.02-3.40)0.04Sheng CS,et al.Hypertension 2013;61:1155-60.Total mortalityCV mortalityc statisticP value*c statisticP value*ABI0.900.54(0.52-0.57)-0.56(0.52-0.59)-+Inter-arm BP difference 15 mmHg0.55(0.52-0.57)0.460.56(0.53-0.60)0.50+Inter-ankle BP difference 15 mm
24、Hg0.59(0.56-0.62)0.00010.62(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-statistic of ABI0.90.Sheng CS,et al.Hypertension 2013;61:1155-60.在在中国老年人群中中国老年人群中，单侧上臂血压的预测价值有限；，单侧上臂血压的预测价值有限；踝臂指数可预测总死亡与心血管死亡；踝臂指数可预测总死亡与心血管死亡；在此基础上，双臂间和双踝间血压差值具有额外的预测价值在此基础上，双臂间和双踝间血压差值具有额外的预测价值。小结小结Sheng CS,et al.Hypertension 2013;61:1155-60.双臂血压双臂血压Total mortality谢谢！谢谢！
