1、測量四肢血壓的預測價值上海交通大學醫學院附屬瑞金醫院上海市高血壓研究所王繼光jiguangw The Shanghai Cardiovascular Health Study (SCHS) The JingNing population studyThe QingPu population studyThe QingPu study in the elderly The NingBo study in the workplace setting baPWV and mortalitySCHS: Objective To investigate the prognostic significan

2、ce 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 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

3、 city centre, to participate in cardiovascular health examinations. 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.

4、Sheng CS, et al. Hypertension 2013; 61:1155-60.OMRON VP-1000SCHS: Four-limb BP and pulse wave velocityFour-limb BP for the calculation of BP differences and ratios, eg, ankle-brachial index (ABI)Pulse wave velocity (brachial-ankle)四肢血壓 上臂血壓 踝臂指數 (ABI) = 較低一側踝部血壓/較高一側肱動脈血壓 雙臂間血壓差值 = 左臂血壓右臂血壓 雙踝間血壓差值

5、= 左踝血壓右踝血壓 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 hazard ratios of total and CV mortality with 4-limb BP ratios and difference, while

6、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 Shen

7、g CS, et al. Hypertension 2013; 61:1155-60.研究結果General outline of the studyNumber of participants: 3133 Median follow-up time: 4.0 yearsCumulative number of person-years: 12,500Number of total deaths: 203Number of CV deaths: 93 (CHD, CHF and stroke)Sheng CS, et al. Hypertension 2013; 61:1155-60.基線特征

8、(1)CharacteristicMen (n=1383)Women (n=1750)P valueAge, years68.57.269.37.50.005Body mass index, kg/m223.43.423.83.70.002Systolic pressure, mm Hg136.518.6141.320.20.0001Diastolic pressure , mm Hg81.510.179.510.10.0001Sheng CS, et al. Hypertension 2013; 61:1155-60.基線特征(2)CharacteristicMen (n=1383)Wome

9、n (n=1750)P valueABI 1.100.101.070.080.0001 0.90, n (%)40 (2.9)43 (2.5)0.45Inter-arm BP difference, mmHg3.713.673.893.840.18 15 mm Hg, n (%)18 (1.3)37 (2.1)0.09 10mm Hg, n (%)76 (5.6)123 (7.0)0.06Inter-ankle BP difference, mmHg6.546.726.266.150.23 15 mm Hg, n (%)113 (8.2)134 (7.7)0.60 10 mm Hg, n (%

10、)284 (20.5)361 (20.6)0.95Sheng CS, et al. Hypertension 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

11、.91-1.51)0.21Mean pressure, +1SD0.80 (0.65-0.99)0.040.80 (0.60-1.08)0.14單側上臂血壓預測價值* 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:

12、1155-60.ABI (-1 SD)Total mortalityCV mortalityHR (95%CI)*P valueHR (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

13、age, sex, body mass index, current smoking, current alcohol intake, systolic and diastolic 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)

14、Sheng CS, et al. Hypertension 2013; 61:1155-60.雙臂間血壓差Total mortality CV mortalityHR (95%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

15、, current smoking, current alcohol intake, use of antihypertensive drugs, diabetes mellitus, serum total cholesterol, and arm systolic and diastolic blood pressure.雙臂間血壓差值預測價值Sheng CS, et al. Hypertension 2013; 61:1155-60.雙臂間血壓差值預測價值Total mortalitySheng CS, et al. Hypertension 2013; 61:1155-60.Event

16、Relative risk (95% CI)0.5 1248 21/199 25.5 9/199 10.9 182/2934 15.5 84/2934 7.210 mmHg All 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 bloo

17、d pressure, hypertension treatment, diabetes mellitus, and serum total cholesterol. All mortality CV mortality 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)雙臂間血壓差值預測價值10 mmHg15 mmHg15mmHgSheng CS, et al. Hypertension 2013; 61:1155-60. 雙踝間血壓差Total mortality CV mortali

18、tyHR (95%CI)*P valueHR (95%CI)*P valueSystolic (+6.40 mmHg)1.15 (1.05-1.27)0.0041.20 (1.06-1.36)0.004Diastolic (+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, di

19、abetes mellitus, serum total cholesterol, and arm systolic and diastolic blood pressure.雙踝間血壓差值預測價值Sheng CS, et al. Hypertension 2013; 61:1155-60.雙踝間血壓差值預測價值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

20、 5.110 mmHgAll mortalityCV mortalityNo. of event / No. on riskRate per 1000 p-yrs1.52 (1.16-2.06) 1.75 (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 chole

21、sterol.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)雙踝間血壓差值預測價值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) 0.0315 vs 151.82 (1.18-