高血压老年人血压发展轨迹与心律失常的相关性  

Correlation between blood pressure development trajectory and arrhythmia in the elderly with hypertension

作　　者：林宇齐 黄莎莎 黄有琪 王凌[3] 陈敏[3] LIN Yuqi;HUANG Shasha;HUANG Youqi;WANG Ling;CHEN Min(School of Pharmacy,Fujian Medical University,Fuzhou,Fujian 350004,China;School of Pharmacy, Fujian University of Traditional Chinese Medicine;Department of Pharmacy, Provincial Hospital of Fuzhou University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital)

机构地区：[1]福建医科大学药学院,福建福州350004 [2]福建中医药大学药学院 [3]福建医科大学省立临床医学院,福建省立医院,福州大学附属省立医院药学部

出　　处：《中华高血压杂志（中英文）》2024年第9期845-851,共7页Chinese Journal of Hypertension

基　　金：福建省科技厅引导性项目(2023Y0045);福建省财政资助项目(006009210417)。

摘　　要：目的 研究我国高血压老年人血压发展轨迹,探索其与心律失常的相关性,为预防心律失常发病提供一种评估途径。方法 选取北京大学健康老龄与发展研究中心的中国老年健康影响因素跟踪调查(CLHLS)队列研究数据库1998—2018年8期纵向数据中符合纳入标准的3 742人作为研究对象,使用R软件构建血压水平发展的组基轨迹模型,根据最小贝叶斯信息准则确定最终模型。采用Cox比例风险回归模型分析不同轨迹组与心律失常的发病风险,对主要的结果进行敏感性分析。结果 最终确定了2个亚组人群收缩压的发展轨迹和3个亚组人群舒张压的变化轨迹,分别是收缩压低-稳定组(3 067名,81.96%)、收缩压高-高组(675名,18.04%)和舒张压低-低组(365名,9.75%)、舒张压中-低组(1 265名,33.81%)、舒张压高-稳定组(2 112名,56.44%),且随着年龄的增长收缩压高-高组的收缩压升高,舒张压中-低组和舒张压低-低组的舒张压降低,而收缩压低-稳定组和舒张压高-稳定组血压保持平稳。Cox回归分析结果显示,在调整性别、年龄、民族、饮酒、吸烟、自评健康后,收缩压高-高组心律失常的发病风险为收缩压低-稳定组的1.94倍(95%CI 1.31~2.88,P<0.001);舒张压高-稳定组的心律失常的发病风险是舒张压低-低组的0.49倍(95%CI 0.30~0.81,P=0.005)。敏感性分析结果与Cox回归分析结果一致。收缩压高-高组心律失常的发病风险高于收缩压低-稳定组;舒张压高-稳定组的心律失常的发病风险低于舒张压低-低组。结论 高血压老年人血压的发展轨迹,特别是收缩压发展轨迹可能是心律失常发病的预测因素,高收缩压将会增加心律失常的发病风险。Objective To investigate the development trajectory of blood pressure in elderly people in China and its correlation with arrhythmia,so as to provide an evaluation method for preventing arrhythmia.Methods A total of 3 742 people who met the inclusion criteria in the 8 longitudinal data periods of the Chinese Longitudinal Healthy Longevity Survey(CLHLS) cohort study database from 1998 to 2018 were selected as the research objects.A group-based trajectory model for blood pressure development was constructed by R software,and the final model was determined according to the minimum Bayesian information criterion.Cox proportional hazards regression model was used to analyze the risk of arrhythmia in different trajectory groups,and sensitivity analysis was performed to analyze the primary outcome.Results The development trajectories of systolic blood pressure(SBP) were determined in 2 subgroups and diastolic blood pressure(DBP) were determined in 3 subgroups,which were labeled as low-stable SBP group(3 067 cases,81.96%),high-high SBP group(675 cases,18.04%),and low-low DBP group(365 cases,9.75%),medium-low DBP group(1 265 cases,33.81%),high-stable DBP group(2 112 cases,56.44%).With the increase of age,the SBP increased in the high-high SBP group,the DBP decreased in the low-low DBP group and medium-low DBP group,and the blood pressure in low-stable SBP group and high-stable DBP group remained stable.After adjusting for sex,age,ethnicity,drinking,smoking,and self-rated health,Cox regression showed that the risk of arrhythmia in the high-high SBP group was 1.94 times(95%CI 1.31-2.88,P<0.001) higher than that in low-stable SBP group.The risk of arrhythmia in the high-stable DBP group was 0.49 times(95%CI 0.30-0.81,P=0.005) lower than that in the low-low DBP group.The results of sensitivity analysis were consistent with those of Cox regression analysis.The risk of arrhythmia in the high-high SBP group was higher than that in the low-stable SBP group.The risk of arrhythmia in the high-stable DBP group was lower than that in

关 键 词：高血压 老年人 心律失常 收缩压 舒张压 轨迹模型 

分 类 号：R544.1[医药卫生—心血管疾病]