文章摘要
邢凤梅,董岩,陶杰,高新颖,周剑辉,陈朔华,季春鹏,姚涛,吴寿岭.单纯舒张期高血压对新发心脑血管事件的影响[J].中华流行病学杂志,2014,35(8):956-960
单纯舒张期高血压对新发心脑血管事件的影响
Impact of isolated diastolic hypertension on new-onset cardiovascular and cerebro-vascular diseases
收稿日期:2014-02-24  出版日期:2014-08-30
DOI:10.3760/cma.j.issn.0254-6450.2014.08.018
中文关键词: 心脑血管事件;单纯舒张期高血压;队列研究
英文关键词: Cardio-cerebral vascular events;Isolated diastolic hypertension;Cohort study
基金项目:
作者单位E-mail
邢凤梅 063000 唐山, 河北联合大学护理与康复学院
延边大学 
 
董岩 开滦总医院林西医院  
陶杰 河北联合大学研究生院  
高新颖 河北联合大学研究生院  
周剑辉 开滦总医院林西医院  
陈朔华 开滦总医院心内科  
季春鹏 河北联合大学研究生院  
姚涛 开滦总医院林西医院  
吴寿岭 开滦总医院心内科 drwusl@163.com 
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中文摘要:
      目的 探讨单纯舒张期高血压(IDH)对新发心脑血管事件(CVD)的影响。方法 采用队列研究方法,以参加2006-2007年度开滦集团公司职工健康体检的101 510例职工中符合“中国高血压防治指南(2010)”正常血压诊断标准(19 460例)及正常血压高值诊断标准(35 448例)、IDH诊断标准(6 780例)的既往无脑梗死、脑出血、蛛网膜下腔出血、心肌梗死、恶性肿瘤病史的61 688例作为观察队列,随访0.5~62.0(47.1±4.8)个月,随访期间每半年收集1次CVD情况。用寿命表法计算正常血压组、正常高值组、IDH组新发CVD的累积发病率,并用log-rank法检验及多变量Cox比例风险回归模型分析IDH对CVD的影响。结果 (1)随访期间,IDH组的总CVD(1.7%)、心肌梗死(0.3%)、脑梗死(1.0%)、脑出血累积发病率(0.4%)均高于正常血压组(0.9%、0.2%、0.6%、0.1%),两组总CVD、脑梗死事件、脑出血累积发病率差异有统计学意义(P<0.05)。(2)校正相关因素后,IDH组发生总CVD、脑梗死、脑出血的HR值分别是正常血压组的1.67倍(95%CI:1.28~2.17)、1.59倍(95%CI:1.12~2.27)和2.67倍(95%CI:1.54~4.65)。(3)对年龄进行分层分析,在<60岁组,校正后IDH组发生脑梗死的HR值为2.22(95%CI:1.41~3.50);在≥60岁组,校正后IDH组发生脑出血的HR值为7.27(95%CI:2.58~20.42)。结论 IDH是总CVD、脑梗死、脑出血的独立预测因子,在不同的年龄层人群中,IDH对不同心脑血管事件的预测价值不同。
英文摘要:
      Objective To explore the impact of isolated diastolic hypertension(IDH) on new-onset cardio-cerebral vascular diseases (CVD). Methods This cohort study involved 101 510 participants who were employees of the Kailuan Group-a state-run coal mining company,in 2006 and 2007. Among them,6 780 subjects were diagnosed with IDH,35 448 subjects were diagnosed with high-normal blood pressure and 19 460 subjects were diagnosed with normal tension. However,none of them had the history of either cardio-cerebral vascular disease or malignant cancer. Cardio-cerebral vascular events including cerebral infarction,cerebral hemorrhage,acute myocardial infarction were recorded every 6 months during the follow-up(47.1±4.8)period. Multivariable Cox proportional hazards regression models were used to analyze the risk factors of first-ever CVD events. Results 1) There were 675 CVD events occurred during the follow-up period.The incidence rates of CVD events (1.7% vs. 0.9%),cerebral infarction (1.0% vs. 0.6%) and cerebral hemorrhage (0.4% vs. 0.1%) were significantly higher in IDH group than that in the normal tension group (all P<0.05). 2) After adjustment for other established CVD risk factors,the hazards ratios became 1.67(95%CI:1.28-2.17) for total CVD events and 1.59(95%CI:1.12-2.27)for cerebral infarction and 2.67(95%CI:1.54-4.65) for cerebral hemorrhage in the IDH group. 3) In stratified analysis on age,after adjustment for other established CVD risk factors,the hazards ratio was 2.22(95%CI:1.41-3.50) for cerebral infarction in lower 60 years old group,while the it was 7.27(95%CI:2.58-20.42) for cerebral hemorrhage in groups older than 60 years of age. Conclusion IDH was the independent risk factor for the total cardio-cerebral vascular events, on both cerebral infarction and cerebral hemorrhage. The predicted values of IDH for different CVD events were diverse on different age groups.
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