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1、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 ,The Shanghai Cardiovascular Health Study (SCHS),The JingNing population study The QingPu population study The QingPu study in the elderly The NingBo study in the workplace setting,baPWV and mortality,SCHS: Objective,To investigate the prognostic significanc
2、e 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-1000,SCHS: Four-limb BP and pulse wave velocity,Four-limb BP for the calculation of BP differences and ratios, eg, ankle-brachial index (ABI) Pulse wave velocity (brachial-ankle),四肢血压,上臂血压 踝臂指数 (ABI) = 较低一侧踝部血压/较高一侧肱动脉血压双臂间血压差值 = 左臂血压右臂血压 双踝间血
5、压差值 = 左踝血压右踝血压 ,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 hazard ratios of total and CV mortality with 4-limb BP ratios and difference,
6、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 met
7、hods,Sheng CS, et al. Hypertension 2013; 61:1155-60.,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 deaths: 93 (CHD, CHF and stroke),Sheng CS, et al. Hypertension 2013;
8、 61:1155-60.,基线特征(1),Sheng CS, et al. Hypertension 2013; 61:1155-60.,基线特征(2),Sheng CS, et al. Hypertension 2013; 61:1155-60.,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 tot
9、al cholesterol.,Sheng CS, et al. Hypertension 2013; 61:1155-60.,* 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.,ABI预测价值: Cont
10、inuous analysis,Sheng CS, et al. Hypertension 2013; 61:1155-60.,ABI预测价值：Kaplan-Meier curve,Sheng CS, et al. Hypertension 2013; 61:1155-60.,ABI预测价值：Cox regression,Event,Relative risk* (95% CI),0.5,1,2,4,8,ABI0.9,ABI0.9,All mortality CV mortality,No. of event / No. on risk,Rate per 1000 p-yrs,2.02 (1.
11、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,ABI0.95,All mortality CV mortality,39/175 55.822/175 31.5,164/2958 13.97
12、1/2958 6.0,2.23 (1.52-3.26) 2.12 (1.24-3.64),Sheng CS, et al. Hypertension 2013; 61:1155-60.,* 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
13、blood pressure.,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,Total mortality,Sheng CS, et al. Hypertension 2013; 61:1155-60.,Event,Relative risk (95% CI),0.5,1,2,4,8,10 mmHg,All mortalityCV mortality,No. of event / No. on risk,Rate per 1000 p-yrs,1.72 (1.06-2.80) 1.45 (0.7
14、0-3.00),* 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 mortality,9/55 40.34/55 17.9,194/3078 15.889/3078 7.2,2.47 (1.24-4.93) 2.11 (0.75-
15、5.96),双臂间血压差值预测价值,10 mmHg,15 mmHg,15mmHg,Sheng CS, et al. Hypertension 2013; 61:1155-60.,* 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 bloo
16、d pressure.,双踝间血压差值预测价值,Sheng CS, et al. Hypertension 2013; 61:1155-60.,双踝间血压差值预测价值,Total mortality,Sheng CS, et al. Hypertension 2013; 61:1155-60.,Event,Relative risk (95% CI),0.5,1,2,4,8,10 mmHg,All mortality CV mortality,No. of event / No. on risk,Rate per 1000 p-yrs,1.52 (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 cholesterol.,
