中国全科医学 ›› 2022, Vol. 25 ›› Issue (32): 4029-4035.DOI: 10.12114/j.issn.1007-9572.2022.0348

所属专题: 高血压最新文章合集

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臂间收缩压差对原发性高血压患者发生动脉硬化的影响研究

闫家富, 郑恪扬, 刘茹菲, 曾荣, 刘傲亚, 程文立*()   

  1. 100029 北京市,首都医科大学附属北京安贞医院 北京市心肺血管疾病研究所高血压中心
  • 收稿日期:2022-03-20 修回日期:2022-06-16 出版日期:2022-11-15 发布日期:2022-08-11
  • 通讯作者: 程文立
  • 闫家富,郑恪扬,刘茹菲,等.臂间收缩压差对原发性高血压患者发生动脉硬化的影响研究[J].中国全科医学,2022,25(32):4029-4035. [www.chinagp.net]
    作者贡献:闫家富、程文立进行文章的构思与设计;闫家富、郑恪扬、刘茹菲进行数据收集,撰写论文;曾荣、刘傲亚、程文立进行研究的实施与可行性分析;闫家富进行数据整理,结果的分析与解释;闫家富、郑恪扬进行统计学处理,论文的修订,英文的修订;郑恪扬、刘傲亚、程文立负责文章的质量控制及审校;程文立对文章整体负责,监督管理。

Association of Inter-arm Systolic Blood Pressure Difference with Arterial Stiffness among Patients with Essential Hypertension

YAN Jiafu, ZHENG Keyang, LIU Rufei, ZENG Rong, LIU Aoya, CHENG Wenli*()   

  1. Hypertension Center, Beijing Anzhen Hospital, Capital Medical University/Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
  • Received:2022-03-20 Revised:2022-06-16 Published:2022-11-15 Online:2022-08-11
  • Contact: CHENG Wenli
  • About author:
    YAN J F, ZHENG K Y, LIU R F. et al. Association of inter-arm systolic blood pressure difference with arterial stiffness among patients with essential hypertension [J]. Chinese General Practice, 2022, 25 (32) : 4029-4035.

摘要: 背景 臂间收缩压差(IASBPD)与心血管事件发生风险增加有关,这一关系可能由动脉硬化介导。 目的 探讨IASBPD对原发性高血压患者发生动脉硬化的影响。 方法 本研究为回顾性研究,连续纳入2019年12月至2021年9月就诊于首都医科大学附属北京安贞医院的6 834例原发性高血压患者,根据IASBPD将患者分为三组,以臂踝脉搏波速度(baPWV)数值为动脉硬化判定标准,采用线性回归和Logistic回归模型分析IASBPD对动脉硬化发生的影响。根据回归分析结果,进一步采用多因素Logistic回归进行亚组分析,探讨各影响因素和其交互作用对动脉硬化发生的影响。 结果 根据IASBPD将患者分为IASBPD<5 mm Hg(n=4 248)、5 mm Hg≤IASBPD<10 mm Hg(n=1 806)和IASBPD≥10 mm Hg(n=780)三组。原发性高血压患者的中位baPWV为1 572(1 392,1 702)cm/s,按照baPWV>1 800 cm/s的标准,动脉硬化患者共1 043例(15.26%)。多元线性回归分结果析显示,IASBPD是臂踝脉搏波速度(baPWV)的影响因素,IASBPD每增加1 mm Hg,baPWV增加4.31 cm/s〔B=4.31,95%CI(3.29,5.31),P<0.05〕;多因素Logistic回归分析结果显示,IASBPD≥10 mm Hg是动脉硬化发生的危险因素〔OR=2.28,95%CI(1.76,2.94),P<0.05〕。亚组分析的结果显示,在低密度脂蛋白胆固醇(LDL-C)≥3.4 mmol/L的患者中,IASBPD≥10 mm Hg与动脉硬化风险增加的关系更显著(P=0.021)。 结论 IASBPD≥10 mm Hg是原发性高血压患者发生动脉硬化的危险因素,在LDL-C≥3.4 mmol/L的患者中更显著。IASBPD可作为一个简单、有效的评估动脉硬化的指标。

关键词: 高血压, 动脉硬化, 臂间收缩压差, 臂踝脉搏波速度, 影响因素分析

Abstract:

Background

Inter-arm systolic blood pressure difference (IASBPD) is associated with an increased risk of cardiovascular events, which may be involved with arterial stiffness.

Objective

To investigate the association of IASBPD with arterial stiffness in essential hypertension.

Methods

This retrospective study consecutively included 6 834 patients with essential hypertension who were admitted to Beijing Anzhen Hospital, Capital Medical University from December 2019 to September 2021. The patients were divided into three groups according to IASBPD. Arterial stiffness was assessed by the value of brachial-ankle pulse wave velocity (baPWV). Multiple linear regression and multivariate Logistic regression models were used to analyze the association of arterial stiffness with IASBPD, then based on this, multivariate Logistic regression was further used for subgroup analysis to explore the impact of each influencing factor and their interaction on arterial stiffness.

Results

The IASBPD tertile groups were: IASBPD<5 mm Hg (n=4 248), 5 mm Hg≤IASBPD<10 mm Hg (n=1 806) and IASBPD≥10 mm Hg (n=780) .The median baPWV was 1 572 (1 392, 1 702) cm/s. The prevalence of arterial stiffness (defined as baPWV>1 800 cm/s) was 15.26% (1 043/6 834). Multiple linear regression analysis showed that IASBPD was associated with baPWV, and an increase in IASBPD by 1 mm Hg corresponded to an increase of 4.31 cm/s in baPWV〔B=4.31, 95%CI (3.29, 5.31), P<0.05〕. Multivariate Logistic regression analysis demonstrated that IASBPD≥10 mm Hg was associated with increased risk of arterial stiffness〔OR=2.28, 95%CI (1.76, 2.94), P<0.05〕, and the risk was much higher in those with LDL-C≥3.4 mmol/L (P=0.021) indicated by further subgroup analysis.

Conclusion

IASBPD≥10 mm Hg was a risk factor of arterial stiffness among essential hypertensive patients, especially in those with LDL-C≥3.4 mmol/L. IASBPD might be used as a simple and effective predictor of arterial stiffness.

Key words: Hypertension, Arterial stiffness, Inter-arm systolic blood pressure difference, Brachial-ankle pulse wave velocity, Root cause analysis