2866例老年社区人群单纯收缩期高血压对预后影响的研究

目的探讨单纯收缩期高血压(ISH)对老年人长期预后的影响。方法在北京市城乡60岁及以上的老年人中抽取一个有代表性的社区人群为研究对象。于1993年开始基线调查,随访调查11年,观察不同血压的老年人心脑血管疾病的死亡及全因死亡情况。结果(1)老年人中高血压患病率为61.7%,其中ISH占27.8%。老年人的收缩压(SBP)随年龄的增长逐渐增高。(2)随访11年显示高血压组老年人总死亡率及心脑血管疾病死亡率均显著高于血压正常组。老年ISH总体死亡率为55.2%,显著高于血压正常组(46.2%)。ISH的死亡风险是正常者的1.4倍,如合并舒张压增高,则死亡风险是正常者的1.6倍,同时增加心脑血管疾病死亡率。SBP在120～139 mm Hg (1 mm Hg=0.133 kPa)水平的死亡率最低,140 mm Hg以上随着SBP水平升高,死亡率增加。结论SBP是影响老年人总死亡和脑血管病死亡的独立危险因素;ISH是影响老年人预后的危险因素。

Study on the isolated systolic hypertension and its prognosis among 2866 elderly residents at the community level in Beiing

Objective We followed a group of community residents above 60 years old to investigate how isolated systolic hypertension (ISH) could influence the prognosis in the long run among the elderly. Methods A selected sample of 60 year olds and over from the Beijing residential communities was randomized ascertained to a longitudinal study.Baseline data was collected in 1993 and 11 years later in 2004,the all-cause death,mortality of cardiovascular and cerebrovascular diseases were observed and analyzed.Results (1)The morbidity of hypertension(HT) was 61.7% and ISH was 27.8% seen in baseline survey while the SBP was increasing with age.(2)The longitudinal study showed that the total mortality and the mortality of cardiovascular and cerebrovascular diseases in HT group were higher than in the normal blood pressure(BP) group.The total mortality in the group ISH was higher than in normal BP group (55.2%:46.2%;P<0.01).The mortality OR for group ISH/group normal BP was 1.4 and group DSH/group normal BP was 1.6,The level of SBP was related to prognosis too which showed that the mortality appeared the lowest in 120-139 mm Hg group,and increased when the level of SBP was above 140 mm Hg.Conclusion SBP was an independent risk factor on the all-cause mortality and the mortality of cerebrovascular diseases in eldevly.ISH also appeared a risk factor on the prognosis among the elderly, suggesting that more attention should be paid to it and treatment be carefully addressed.