血压达标降低高血压患者发生左束支传导阻滞的风险  

Achieving blood pressure control targets reduces the risk of left bundle branch block in patients with hypertension

作　　者：陈永刚 吴寿岭[2] 王丽文 陈朔华[2] 杨凯 熊海亮 张艳敏 姜春宇 陈新刚 高明 汪国栋[2] CHEN Yonggang;WU Shouling;WANG Liwen;CHEN Shuohua;YANG Kai;XIONG Hailiang;ZHANG Yanmin;JIANG Chunyu;CHEN Xingang;GAO Ming;WANG Guodong(Department of Cardiology,Tangshan Central Hospital,Tangshan Hebei 063000,China;Department of Cardiology,Tangshan Kailuan General Hospital;Department of Gastroenterology,Tangshan Central Hospital;Department of Cardiology,Luannan County Hospital,Tangshan)

机构地区：[1]唐山中心医院心内科,河北唐山063000 [2]唐山开滦总医院心内科 [3]唐山中心医院消化内科 [4]唐山滦南县医院心血管内科

出　　处：《中华高血压杂志（中英文）》2024年第11期1033-1042,共10页Chinese Journal of Hypertension

摘　　要：目的研究不同血压达标情况对新发左束支传导阻滞(LBBB)的影响。方法回顾性分析2006年7月至2007年10月参加健康查体的88553例开滦员工的基线及随访数据,依据随访初始血压值及高血压病史分为非高血压组及高血压组,进一步将高血压组划分为随访初始血压达标组及随访初始血压不达标组,再依据随访期末血压值对随访初始血压不达标组再次划分为随访期末血压达标组及随访期末血压不达标组。采用多因素Cox比例风险模型分析不同血压达标情况对新发LBBB的影响。对不同年龄、性别进行亚组分析,并分别排除糖尿病、慢性肾脏病(CKD)、心肌梗死或心力衰竭进行敏感性分析。结果非高血压组50505例,高血压组38048例,高血压人群中随访初始血压达标组2607例,随访初始血压不达标组35441例,随访初始血压不达标人群中随访期末血压达标组10658例,随访期末血压不达标组24783例。经过(10.15±3.44)年的随访,研究人群共发生LBBB 1010例。非高血压组LBBB的发病密度为0.80/千人年,高血压组为1.58/千人年(Log-Rank检验:P<0.01);高血压人群中随访初始血压达标组为1.04/千人年,随访初始血压不达标组为1.62/千人年;随访期末血压达标组为1.32/千人年,随访期末血压不达标组为1.76/千人年。多因素Cox比例风险模型分析结果显示,以非高血压组为参照,校正各种影响因素后,高血压组发生LBBB的HR(95%CI)为1.42(1.24~1.62);随访初始血压达标组及不达标组发生LBBB的HR(95%CI)分别为0.97(0.66~1.44)和1.45(1.27~1.66);随访初始血压不达标组人群中随访期末血压达标及随访期末血压不达标组发生LBBB的HR(95%CI)分别为1.27(1.04~1.54)及1.53(1.33~1.77)。结论高血压为新发LBBB的危险因素,降压达标可降低新发LBBB的风险。Objective To investigate the impact of different blood pressure control statuses on newly developed left bundle branch block(LBBB).Methods Aretrospective cohort study was conducted.A total of 88553 Kailuan employees who underwent health examinations from July 2006 to October 2007 were recruited and categorized into non-hypertension and hypertension groups based on the blood pressure values and hypertension history at the beginning of follow-up.The hypertensive patients were further divided into two groups:initial blood pressure controlled group and initial blood pressure uncontrolled group based on the blood pressure values at the beginning of follow-up.According to the blood pressure value at the end of follow-up,the patients with initial blood pressure uncontrolled were divided into the follow-up blood pressure controlled group and uncontrolled group.The impact of different blood pressure control statuses on the occurrence of newly developed LBBB was analyzed using a multifactorial Cox proportional hazards model.Stratified analyses by age and gender were performed,along with sensitivity analyses excluding participants with diabetes,chronic kidney disease(CKD),heart attack,or heart failure.Results The non-hypertension group comprised 50505 individuals,while the hypertension group comprised 38048 individuals.Among the hypertensives,2607 patients had controlled blood pressure and 35441 patients had uncontrolled blood pressure at the beginning of follow-up.Among the patients with uncontrolled initial blood pressure,10658 patients had controlled blood pressure and 24783 patients had uncontrolled blood pressure at the end of follow-up.Over a follow-up period of(10.15±3.44)years,a total of 1010 cases of LBBB occurred.The incidence density of LBBB was 0.80/1000 person-years in the non-hypertension group,1.58/1000 person-years in the hypertension group(Log-Rank test P<0.001),1.04/1000 person-years in the initial blood pressure controlled group,1.62/1000 person-years in the initial blood pressure uncontrolled group,1.32

关 键 词：高血压 血压达标 左束支传导阻滞 

分 类 号：R544.1[医药卫生—心血管疾病]