Hypertension:较高和较低手臂收缩压与心血管结局之间的关系

2022-08-06 MedSci原创 MedSci原创

使用较高上臂BP值而不是较低上臂BP值将12%的受试者重分类。所有预测模型在使用较高上臂BP时均具有较好的性能。为了准确诊断和治疗高血压,两臂均应进行测量。

指南建议测量两臂血压(BP),并采用较高的手臂读数进行诊断和处理。目前还缺乏支持这一建议的数据。

近日,心血管权威杂志Hypertension上发表了一篇研究文章,研究人员利用来自手臂间血压差异-个体参与者数据协作的数据,评估了较高手臂和较低手臂收缩期BP与高血压诊断和治疗阈值以及预后之间的关系。

研究人员采用单阶段多变量Cox回归模型(按研究分层),对来自23个队列的个体参与者数据进行荟萃分析,以评估较高或较低手臂BP读数与心血管死亡、全因死亡和心血管事件之间的关系。研究人员采用弗雷明汉和动脉粥样硬化性心血管疾病风险评分为模型来评估心血管事件,并通过赤池信息准则来比较模型的拟合度。根据指南推荐的干预阈值重分类比例进行了比较。

研究人员分析了53172名参与者,他们的平均年龄为60岁;48%为女性。在130或140mmHg收缩压阈值时,与较低的上臂血压相比,较高的上臂血压对12%的参与者进行了重分类(所有P<0.001)。较高的上臂血压模型更适合全因死亡、心血管死亡和心血管事件(所有P<0.001)。较高的上臂BP模型能更好地预测弗雷明汉心血管事件和动脉粥样硬化性心血管疾病风险评分(所有P<0.001),与较低上臂BP模型相比,分别有4.6%和3.5%的参与者被重新归类为高风险类别。

由此可见,使用较高上臂BP值而不是较低上臂BP值将12%的受试者重分类。所有预测模型在使用较高上臂BP时均具有较好的性能。为了准确诊断和治疗高血压,两臂均应进行测量。

原始出处:

Christopher E. Clark.et al.Higher Arm Versus Lower Arm Systolic Blood Pressure and Cardiovascular Outcomes: a Meta-Analysis of Individual Participant Data From the INTERPRESS-IPD Collaboration.Hypertension.2022.https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.121.18921

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