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  

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

作　　者：闫家富 郑恪扬 刘茹菲 曾荣 刘傲亚 程文立 YAN Jiafu;ZHENG Keyang;LIU Rufei;ZENG Rong;LIU Aoya;CHENG Wenli(Hypertension Center,Beijing Anzhen Hospital,Capital Medical University/Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]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,北京市100029

出　　处：《中国全科医学》2022年第32期4029-4035,共7页Chinese General Practice

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6834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=4248)、5 mm Hg≤IASBPD<10 mm Hg(n=1806)和IASBPD≥10 mm Hg(n=780)三组。原发性高血压患者的中位baPWV为1572(1392,1702)cm/s,按照baPWV>1800 cm/s的标准,动脉硬化患者共1043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。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 6834 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=4248),5 mm Hg≤IASBPD<10 mm Hg(n=1806)and IASBPD≥10 mm Hg(n=780).The median baPWV was 1572(1392,1702)cm/s.The prevalence of arterial stiffness(defined as baPWV>1800 cm/s)was 15.26%(1043/6834).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.

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 

分 类 号：R544.1[医药卫生—心血管疾病] R543.5[医药卫生—内科学]