社区老年高血压患者基线血压水平对远期衰弱发生的影响  

Influence of baseline blood pressure level on long-term occurrence of frailty in community-dwelling older adults with hypertension

作　　者：吴冰 胡亦新[2,4] 闫瑾 张天一 杨存美 鲁冰杰 底宁 祝志辉 范利 Wu Bing;Hu Yixin;Yan Jin;Zhang Tianyi;Yang Cunmei;Lu Bingjie;Di Ning;Zhu Zhihui;Fan Li(Graduate School,Chinese PLA General Hospital,Beijing 100853;National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853;Troop 663366,Baoding 071000,Hebei Province,China;Fourth Geriatric Health Care Department of Second Medical Center,Chinese PLA General Hospital,Beijing 100853;Institute of Hospital Management of Medical Innovation Research Department,Chinese PLA General Hospital,Beijing 100853;Graduate School of Jilin Sport University,Changchun 130022,China;School of Physical Education,Ningxia University,Yinchuan 750021,China;Department of Cardiology of Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院研究生院,北京100853 [2]中国人民解放军总医院国家老年疾病临床医学研究中心,北京100853 [3]66336部队,河北保定071000 [4]中国人民解放军总医院第二医学中心保健四科,北京100853 [5]中国人民解放军总医院医学创新研究部医院管理研究所,北京100853 [6]吉林体育学院研究生院,长春130022 [7]宁夏大学体育学院,银川750021 [8]中国人民解放军总医院第二医学中心心血管内科,北京100853

出　　处：《中华老年多器官疾病杂志》2023年第6期401-406,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：军队保健专项科研课题(20BJZ30,18BJZ32);国家老年疾病临床医学研究中心开放课题(NCRCG-PLAGH-2022008)。

摘　　要：目的探究社区老年高血压患者基线血压水平对远期衰弱发生的影响,为老年高血压患者的科学化血压管理提供依据。方法纳入2019年1月至6月在北京市某社区接受老年综合评估且资料完整的老年非衰弱高血压患者,并于2023年1月1日至2月14日期间进行电话随访,最终共有372例老年高血压患者纳入本研究。随访时采用FRAIL量表评估衰弱,评分≥3分为衰弱。采用二项logistic回归分析(输入法)计算基线血压水平与远期衰弱发生的OR和95%CI;使用广义相加模型对基线血压水平与远期衰弱发生的剂量反应关系进行平滑曲线拟合和阈值效应分析。采用Empower Stats软件和SPSS 25.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、Mann-Whitney U检验及χ^(2)检验。结果多因素调整的logistic回归分析结果显示,基线收缩压、舒张压水平与衰弱发生无显著相关;基线脉压水平与衰弱发生呈负相关(OR=0.983,95%CI 0.968~0.998;P<0.05);平滑曲线拟合和阈值效应分析结果显示,基线收缩压水平与衰弱发生呈U型曲线关系,U型曲线的拐点在140 mmHg(1 mmHg=0.133 kPa);当收缩压<140 mmHg时,基线收缩压与衰弱发生呈负相关(OR=0.957,95%CI 0.925~0.990,P=0.012);当收缩压>140 mmHg时,呈正相关趋势,但不显著(OR=1.006,95%CI 0.985~1.028,P=0.578)。结论社区老年高血压患者中,基线收缩压水平对远期衰弱发生存在影响,呈U型曲线关系,U型曲线的拐点为140 mmHg。Objective To explore the influence of baseline blood pressure on the long-term development of frailty in community-dwelling older adults with hypertension to provide a basis for scientific blood pressure management of elderly hypertension patients.Methods The elderly non-frailty hypertension patients who had complete sociodemographic data and results of comprehensive geriatric assessment in a community in Beijing from January to June 2019 were subjected in this study,and they were followed up by telephone from January 1 to February 14,2023.Finally,372 elderly hypertension patients were enrolled in this study.FRAIL scale was used to evaluate frailty in the follow-up,and those with the score≥3 points were classified as frailty.Binomial logistic regression analysis(input method)was adopted to calculate the OR and 95%CI between baseline blood pressure level and long-term occurrence of frailty.The dose-response relationship between the baseline level and the occurrence was analyzed by generalized additive model using smooth curve fitting and threshold effect analysis.Empower Stats and SPSS 25.0 were used for statistical analysis.Data comparison between two groups was performed using student′s t test,Mann-Whitney U test or Chi-square test depending on data type.Results Multivariate adjusted logistic regression analysis showed that baseline systolic and diastolic blood pressure levels were not significantly correlated with occurrence of frailty,while baseline pulse pressure was negatively with the occurrence(OR=0.983,95%CI 0.968-0.998;P<0.05).Smooth curve fitting and threshold effect analysis indicated that the relationship between baseline systolic blood pressure level and frailty was U-shaped,with an inflection point of the U-shaped curve of 140 mmHg(1 mmHg=0.133 kPa).When systolic blood pressure<140 mmHg,the OR(95%CI)was 0.957(0.925-0.990;P<0.05),and when systolic blood pressure>140 mmHg,the OR(95%CI)was 1.006(0.985-1.028;P>0.05).Conclusion In community-dwelling older adults with hypertension,baseline systolic bl

关 键 词：老年人 高血压 收缩压 衰弱 老年综合评估 

分 类 号：R592[医药卫生—老年医学]