脉压分布与脑卒中和心肌梗死患病率的关系

目的　探讨脉压在我国人群中的分布特征及与主要心血管疾病的关系。方法　对1991年全国第三次高血压抽样调查中年龄≥ 18岁的 882 6 81人的资料进行再分析。统计分析采用t检验、χ2 检验 ,多因素分析使用logistic回归模型。结果　 (1)人群的脉压均值为 (44 6 1± 13 5 9)mmHg(1mmHg =0 133kPa) ,其中男性为 (44 92± 12 72 )mmHg,女性为 (44 34± 14 32 )mmHg。随年龄的增长脉压逐渐增宽 ,5 0岁以后脉压增宽的幅度加速且女性高于男性。在≥ 6 0岁人群中 ,脉压≥ 6 0mmHg的比例高于 <6 0岁组人群。 (2 )随脉压增宽 ,脑卒中和心肌梗死的患病率也呈增加趋势。 (3)多因素logistic回归模型分析显示 ,调整了性别、年龄、体重指数、吸烟及饮酒后 ,以脉压 <4 5mmHg的人群为基线组 ,脉压为 4 5～ 5 9、6 0～ 74和≥ 75mmHg组人群 ,脑卒中的患病危险分别是基线组的 1 9、3 5和 5倍。同样 ,心肌梗死的患病危险是基线组的 1 2、1 5和 1 7倍。将收缩压和舒张压纳入影响因素中再分析 ,仍显示脑卒中和心肌梗死的患病危险随脉压的增宽而增加。结论脑卒中和心肌梗死的患病率随脉压的增宽而增高 ,脉压增宽是脑卒中和心肌梗死患病的危险因素之一 ,尤其在老年人群中更为明显。

Pulse pressure and prevalence of stroke and myocardial infarction in Chinese population

OBJECTIVE: To explore the characteristics of distribution of pulse pressure (PP) in Chinese population and its relationship to major cardiovascular diseases in them. METHODS: Data from the Third National Blood Pressure Survey involved 882,681 subjects aged over 18 in 1991 were reanalysed for the relationship between PP and risks of major cardiovascular diseases, with t-test, chi2 test and logistic regression model. PP is defined as the difference between systolic and diastolic blood pressure. RESULTS: (1) Overall mean PP was (44.61 +/- 13.59) mm Hg for the subjects aged over 18, higher in men (44.92 +/- 12.72) mmHg] than that in women (44.34 +/- 14.32) mmHg]. PP increased progressively with age, and its increase accelerated significantly at age over 50 but higher in women than in men. Proportion of the subjects with PP equal to or greater than 60 mmHg was more in those aged 60 or over than that in younger ones. (2) Prevalence of stroke and myocardial infarction (MI) increased with PP and age, whether in the normotensives, or in the hypertensives or in the isolated systolic hypertensives. (3) Results of multivariate logistic regression analysis revealed that risks of stroke in the subjects with PP of (45-59) mmHg, (60-74) mmHg and over 75 mmHg were 1.9, 3.5 and 5 times as in those with PP less than 45 mm Hg, respectively, adjusted for other risk factors, and their risks of myocardial infarction (MI) were 1.2, 1.5 and 1.7 times, respectively. Furthermore, PP was significantly and independently related to the risks of stroke and MI, even adjusted for systolic and diastolic pressures. CONCLUSIONS: Prevalence of stroke and MI increased with the breadth of PP and age. Broader PP may be an important and independent predictor of risks of stroke and MI, especially in the aged people.