测量四肢血压的预测价值学习教案

1、会计学1测量四肢血压测量四肢血压(xuy)的预测价值的预测价值第一页，共28页。nThe JingNing population studynThe QingPu population studynThe QingPu study in the elderly nThe NingBo study in the workplace setting 第1页/共27页第二页，共28页。第2页/共27页第三页，共28页。To investigate the prognostic significance of four-limb blood pressure for total and CV mort

2、ality in an elderly ( 60 years) Chinese population. Sheng CS, et al. Hypertension 2013; 61:1155-60.第3页/共27页第四页，共28页。nWe invited all residents of 60 years or older from villages and communities of a town in the suburb of Shanghai, 30 km from the city centre, to participate in cardiovascular health ex

3、aminations. nOur study started in 2006 on subjects in the age range from 60 to 69 years, and then in 2007 on subjects of 70 years or older. These subjects were followed up for events, and repeated examinations were performed once every 2 years. Sheng CS, et al. Hypertension 2013; 61:1155-60.第4页/共27页

4、第五页，共28页。OMRON VP-1000SCHS: Four-limb BP and pulse wave velocityFour-limb BP for the calculation of BP differences and ratios, eg, ankle-brachial index (ABI)Pulse wave velocity (brachial-ankle)第5页/共27页第六页，共28页。四肢四肢(szh)(szh)血压血压u 上臂血压上臂血压(xuy) (xuy) u 踝臂指数踝臂指数 (ABI) (ABI) = = 较低一侧踝部血压较低一侧踝部血压(xuy)/(

5、xuy)/较高一侧肱动脉血较高一侧肱动脉血压压(xuy)(xuy)u 双臂间血压双臂间血压(xuy)(xuy)差值差值 = = 左臂血压左臂血压(xuy)(xuy)右臂血压右臂血压(xuy) (xuy) u 双踝间血压双踝间血压(xuy)(xuy)差值差值 = = 左踝血压左踝血压(xuy)(xuy)右踝血压右踝血压(xuy) (xuy) Sheng CS, et al. Hypertension 2013; 61:1155-60.第6页/共27页第七页，共28页。Means and proportions were compared with the student t-test and F

6、ishers exact test, respectively. Multiple Cox regression analyses were used to determine the hazard ratios of total and CV mortality with 4-limb BP ratios and difference, while controlling for covariates.The log-rank test was used to compare the cumulative incidence of mortality between groups, with

7、 Kaplan-Meier survival curve to show the time to deaths.The C-statistic analysis was performed to examine the incremental prognostic value for mortality.Statistical methods Sheng CS, et al. Hypertension 2013; 61:1155-60.第7页/共27页第八页，共28页。第8页/共27页第九页，共28页。Number of participants: 3133 Median follow-up

8、time: 4.0 yearsCumulative number of person-years: 12,500Number of total deaths: 203 Number of CV deaths: 93 (CHD, CHF and stroke)Sheng CS, et al. Hypertension 2013; 61:1155-60.第9页/共27页第十页，共28页。CharacteristicMen (n=1383)Women (n=1750)P valueAge, yearsAge, years68.57.269.37.50.005Body mass index, kg/m

9、Body mass index, kg/m2 223.43.423.83.70.002Systolic pressure, mm HgSystolic pressure, mm Hg136.518.6141.320.20.0001Diastolic pressure , mm HgDiastolic pressure , mm Hg81.510.179.510.10.0001Sheng CS, et al. Hypertension 2013; 61:1155-60.第10页/共27页第十一页，共28页。CharacteristicMen (n=1383)Women (n=1750)P val

10、ueABI ABI 1.100.101.070.080.0001 0.90, n (%) 0.90, n (%)40 (2.9)43 (2.5)0.45Inter-arm BP difference, mmHgInter-arm BP difference, mmHg3.713.673.893.840.18 15 mm Hg, n (%) 15 mm Hg, n (%)18 (1.3)37 (2.1)0.09 10mm Hg, n (%) 10mm Hg, n (%)76 (5.6)123 (7.0)0.06Inter-ankle BP difference, mmHgInter-ankle

11、BP difference, mmHg6.546.726.266.150.23 15 mm Hg, n (%) 15 mm Hg, n (%)113 (8.2)134 (7.7)0.60 10 mm Hg, n (%) 10 mm Hg, n (%)284 (20.5)361 (20.6)0.95Sheng CS, et al. Hypertension 2013; 61:1155-60.第11页/共27页第十二页，共28页。Total mortality CV mortalityHR (95% CI)*P valueHR (95% CI)*P valueSystolic BP, +1SD1.

12、04 (0.80-1.25)0.711.11 (0.84-1.48)0.46Diastolic BP, +1SD0.81 (0.65-1.01)0.060.78 (0.57-1.08)0.13Pulse pressure, +1SD1.12 (0.94-1.33)0.201.17 (0.91-1.51)0.21Mean pressure, +1SD0.80 (0.65-0.99)0.040.80 (0.60-1.08)0.14* The analyses were adjusted for age, sex, body mass index, current smoking, current

13、alcohol intake, use of antihypertensive drugs, diabetes mellitus, and serum total cholesterol.Sheng CS, et al. Hypertension 2013; 61:1155-60.第12页/共27页第十三页，共28页。ABI (-1 SD)Total mortalityCV mortalityHR (95%CI)*P valueHR (95%CI)*P valueSystolic BP (-0.09)1.22 (1.10-1.36)0.00031.24 (1.07-1.44)0.005Dias

14、tolic BP (-0.07)1.23 (1.11-1.35)0.00011.24 (1.08-1.41)0.002* The analyses were adjusted for age, sex, body mass index, current smoking, current alcohol intake, use of antihypertensive drugs, diabetes mellitus, serum total cholesterol, and arm systolic and diastolic blood pressure.Sheng CS, et al. Hy

15、pertension 2013; 61:1155-60.第13页/共27页第十四页，共28页。Sheng CS, et al. Hypertension 2013; 61:1155-60.第14页/共27页第十五页，共28页。EventRelative risk* (95% CI) 1248 22/83 65.9 13/83 38.9 181/3050 15.0 80/3050 6.5All mortalityCV mortalityNo. of event / No. on riskRate per 1000 p-yrs2.02 (1.24-3.30)1.70 (0.86-3.39)* Ad

16、justed for age, sex, body mass index, current smoking, current alcohol intake, systolic and diastolic blood pressure, hypertension treatment, diabetes mellitus, and serum total cholesterol.All mortalityCV mortality 164/2958 71/2958 2.23 (1.52-3.26)2.12 (1.24-3.64)Sheng CS, et al. Hypertension 2013;

17、61:1155-60.第15页/共27页第十六页，共28页。双臂间血压差双臂间血压差Total mortality CV mortalityHR (95%CI)*P valueHR (95%CI)*P valueSystolic (+3.76 mmHg)1.16 (1.04-1.30)0.011.18 (1.01-1.40)0.04Diastolic (+3.07 mmHg)1.17 (1.05-1.31)0.0051.23 (1.06-1.44)0.006* The analyses were adjusted for age, sex, body mass index, current s

18、moking, current alcohol intake, use of antihypertensive drugs, diabetes mellitus, serum total cholesterol, and arm systolic and diastolic blood pressure.Sheng CS, et al. Hypertension 2013; 61:1155-60.第16页/共27页第十七页，共28页。Total mortalitySheng CS, et al. Hypertension 2013; 61:1155-60.第17页/共27页第十八页，共28页。

19、EventRelative risk (95% CI) 1248 21/199 25.5 9/199 10.9 182/2934 15.5 84/2934 7.210 mmHg All mortality CV mortalityNo. of event / No. on riskRate per 1000 p-yrs1.72 (1.06-2.80)1.45 (0.70-3.00)* Adjusted for age, sex, body mass index, current smoking, current alcohol intake, systolic and diastolic bl

20、ood pressure, hypertension treatment, diabetes mellitus, and serum total cholesterol. All mortality CV mortality 194/3078 89/3078 2.47 (1.24-4.93)2.11 (0.75-5.96)10 mmHg15 mmHg15mmHgSheng CS, et al. Hypertension 2013; 61:1155-60.第18页/共27页第十九页，共28页。 双踝间血压差双踝间血压差Total mortality CV mortalityHR (95%CI)*

21、P valueHR (95%CI)*P valueSystolic (+6.40 mmHg)1.15 (1.05-1.27)0.0041.20 (1.06-1.36)0.004Diastolic (+3.70 mmHg)1.15 (1.06-1.24)0.00091.17 (1.06-1.30)0.002* The analyses were adjusted for age, sex, body mass index, current smoking, current alcohol intake, use of antihypertensive drugs, diabetes mellit

22、us, serum total cholesterol, and arm systolic and diastolic blood pressure.Sheng CS, et al. Hypertension 2013; 61:1155-60.第19页/共27页第二十页，共28页。Total mortalitySheng CS, et al. Hypertension 2013; 61:1155-60.第20页/共27页第二十一页，共28页。EventRelative risk (95% CI) 1248 73/645 28.1 42/645 16.2 130/2488 13.1 51/248

23、8 5.110 mmHgAll mortalityCV mortalityNo. of event / No. on riskRate per 1000 p-yrs1.52 (1.16-2.06) 1.75 (1.12-2.74)* Adjusted for age, sex, body mass index, current smoking, current alcohol intake, systolic and diastolic blood pressure, hypertension treatment, diabetes mellitus, and serum total cholesterol.All mortalityCV mortality 1.63 (1.12-2.38) 1.89 (1.13-3.18)10 mmHg15 mmHg0.9) Total mortality CV mortalityHR