1. 测量四肢血压的预测价值 上海交通大学医学院附属瑞金医院 上海市高血压研究所 王继光 jiguangw@gmail.com

2. The Shanghai Cardiovascular Health Study (SCHS) The JingNing population study The QingPu population study The QingPu study in the elderly The NingBo study in the workplace setting

3. baPWV and mortality

4. SCHS: Objective To investigate the prognostic significance of four-limb blood pressure for total and CV mortality in an elderly (  60 years) Chinese population. Sheng CS, et al. Hypertension 2013; 61:1155-60.

5. SCHS: Study population We 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 examinations. Our 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.

6. OMRON VP-1000 SCHS: Four-limb BP and pulse wave velocity 1.Four-limb BP for the calculation of BP differences and ratios, eg, ankle-brachial index (ABI) 2.Pulse wave velocity (brachial-ankle)

7. 四肢血压  上臂血压  踝臂指数 (ABI) = 较低一侧踝部血压 / 较高一侧肱动脉血压  双臂间血压差值 =  左臂血压  右臂血压   双踝间血压差值 =  左踝血压  右踝血压  Sheng CS, et al. Hypertension 2013; 61:1155-60.

8.  Means and proportions were compared with the student t-test and Fisher’s 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 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.

9. 研究结果

10. General outline of the study  Number of participants: 3133  Median follow-up time: 4.0 years  Cumulative number of person-years: 12,500  Number of total deaths: 203  Number of CV deaths: 93 (CHD, CHF and stroke) Sheng CS, et al. Hypertension 2013; 61:1155-60.

11. 基线特征 (1) Characteristic Men (n=1383) Women (n=1750) P value Age, years 68.5±7.269.3±7.50.005 Body mass index, kg/m 2 23.4±3.423.8±3.70.002 Systolic pressure, mm Hg 136.5±18.6141.3±20.2<0.0001 Diastolic pressure, mm Hg 81.5±10.179.5±10.1<0.0001 Sheng CS, et al. Hypertension 2013; 61:1155-60.

12. 基线特征 (2) Characteristic Men (n=1383) Women (n=1750) P value ABI 1.10±0.101.07±0.08<0.0001 ≤0.90, n (%) 40 (2.9)43 (2.5)0.45 Inter-arm BP difference, mmHg 3.71±3.673.89±3.840.18 ≥15 mm Hg, n (%) 18 (1.3)37 (2.1)0.09 ≥10mm Hg, n (%) 76 (5.6)123 (7.0)0.06 Inter-ankle BP difference, mmHg 6.54±6.726.26±6.150.23 ≥15 mm Hg, n (%) 113 (8.2)134 (7.7)0.60 ≥10 mm Hg, n (%) 284 (20.5)361 (20.6)0.95 Sheng CS, et al. Hypertension 2013; 61:1155-60.

13. Total mortality CV mortality HR (95% CI)* P value HR (95% CI)* P value Systolic BP, +1SD1.04 (0.80-1.25)0.711.11 (0.84-1.48)0.46 Diastolic BP, +1SD0.81 (0.65-1.01)0.060.78 (0.57-1.08)0.13 Pulse pressure, +1SD1.12 (0.94-1.33)0.201.17 (0.91-1.51)0.21 Mean pressure, +1SD0.80 (0.65-0.99)0.040.80 (0.60-1.08)0.14 单侧上臂血压预测价值 * The analyses were adjusted for age, sex, body mass index, current smoking, current alcohol intake, use of antihypertensive drugs, diabetes mellitus, and serum total cholesterol. Sheng CS, et al. Hypertension 2013; 61:1155-60.

14. ABI (-1 SD) Total mortalityCV mortality HR (95%CI)*P valueHR (95%CI)* P value Systolic BP (-0.09)1.22 (1.10-1.36)0.00031.24 (1.07-1.44)0.005 Diastolic 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. ABI 预测价值 : Continuous analysis Sheng CS, et al. Hypertension 2013; 61:1155-60.

15. ABI 预测价值： Kaplan-Meier curve Sheng CS, et al. Hypertension 2013; 61:1155-60.

16. ABI 预测价值： Cox regression Event Relative risk* (95% CI) 0.5 1 2 4 8 22/83 65.9 13/83 38.9 181/3050 15.0 80/3050 6.5 ABI≤0.9ABI>0.9 All mortality CV mortality No. of event / No. on risk Rate per 1000 p-yrs 2.02 (1.24-3.30) 1.70 (0.86-3.39) * 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. ABI≤0.95ABI>0.95 All mortality CV mortality 39/175 55.8 22/175 31.5 164/2958 13.9 71/2958 6.0 2.23 (1.52-3.26) 2.12 (1.24-3.64) Sheng CS, et al. Hypertension 2013; 61:1155-60.

17. 双臂间血压差 Total mortality CV mortality HR (95%CI)* P value HR (95%CI)* P value Systolic (+3.76 mmHg) 1.16 (1.04-1.30) 0.01 1.18 (1.01-1.40) 0.04 Diastolic (+3.07 mmHg) 1.17 (1.05-1.31) 0.005 1.23 (1.06-1.44) 0.006 * 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. 双臂间血压差值预测价值 Sheng CS, et al. Hypertension 2013; 61:1155-60.

18. 双臂间血压差值预测价值 Total mortality Sheng CS, et al. Hypertension 2013; 61:1155-60.

19. Event Relative risk (95% CI) 0.5 1 2 4 8 21/199 25.5 9/199 10.9 182/2934 15.5 84/2934 7.2 ≥10 mmHg All mortality CV mortality No. of event / No. on risk Rate per 1000 p-yrs 1.72 (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 blood pressure, hypertension treatment, diabetes mellitus, and serum total cholesterol. All mortality CV mortality 9/55 40.3 4/55 17.9 194/3078 15.8 89/3078 7.2 2.47 (1.24-4.93) 2.11 (0.75-5.96) 双臂间血压差值预测价值 <10 mmHg ≥15 mmHg<15mmHg Sheng CS, et al. Hypertension 2013; 61:1155-60.

20. 双踝间血压差 Total mortality CV mortality HR (95%CI)* P value HR (95%CI)* P value Systolic (+6.40 mmHg) 1.15 (1.05-1.27) 0.004 1.20 (1.06-1.36) 0.004 Diastolic (+3.70 mmHg) 1.15 (1.06-1.24) 0.0009 1.17 (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 mellitus, serum total cholesterol, and arm systolic and diastolic blood pressure. 双踝间血压差值预测价值 Sheng CS, et al. Hypertension 2013; 61:1155-60.

21. 双踝间血压差值预测价值 Total mortality Sheng CS, et al. Hypertension 2013; 61:1155-60.

22. Event Relative risk (95% CI) 0.5 1 2 4 8 73/645 28.1 42/645 16.2 130/2488 13.1 51/2488 5.1 ≥10 mmHg All mortality CV mortality No. of event / No. on risk Rate per 1000 p-yrs 1.52 (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 mortality CV mortality 40/244 41.8 26/244 27.5 163/2889 14.1 67/2889 5.8 1.63 (1.12-2.38) 1.89 (1.13-3.18) 双踝间血压差值预测价值 <10 mmHg ≥15 mmHg<15mmHg Sheng CS, et al. Hypertension 2013; 61:1155-60.

23. * 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. Sensitivity analysis (ABI>0.9) Total mortalityCV mortality HR (95% CI)* P value HR (95% CI)* P value Inter-arm BP difference, mm Hg ≥10 vs <10 1.44 (0.78-2.65) 0.24 1.29 (0.50-3.31) 0.59 ≥15 vs <15 2.04 (0.74-5.65) 0.17 2.36 (0.54-10.29) 0.25 Inter-ankle BP difference, mm Hg ≥10 vs <10 1.63 (1.17-2.27) 0.004 1.70 (1.05-2.77) 0.03 ≥15 vs <15 1.82 (1.18-2.80) 0.006 1.86 (1.02-3.40) 0.04 Sheng CS, et al. Hypertension 2013; 61:1155-60.

24. Total mortalityCV mortality c statistic P value* c statistic P value* ABI≤0.90 0.54 (0.52-0.57) - 0.56 (0.52-0.59) - +Inter-arm BP difference ≥ 15 mmHg 0.55 (0.52-0.57) 0.46 0.56 (0.53-0.60) 0.50 +Inter-ankle BP difference ≥ 15 mmHg 0.59 (0.56-0.62) <0.0001 0.62 (0.57-0.67) <0.0001 +Inter-arm BP difference ≥ 15 mmHg and Inter-ankle BP difference ≥ 15 mmHg 0.60 (0.57-0.62) <0.0001 0.63 (0.58-0.67) <0.0001 Incremental prognostic value *For the comparison with the c-statistic of ABI≤0.90. Sheng CS, et al. Hypertension 2013; 61:1155-60.

25.  在中国老年人群中，单侧上臂血压的预测价值有限；  踝臂指数可预测总死亡与心血管死亡；  在此基础上，双臂间和双踝间血压差值具有额外的预测价值。 小结 Sheng CS, et al. Hypertension 2013; 61:1155-60.

26. 双臂血压 Total mortality

27. 谢谢！