单纯舒张期高血压对新发心脑血管事件的影响

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(35448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.%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.