【高血壓英文課件】惡性高血壓-Uncontrolled-Hypertension

UncontrolledHypertension,SystolicandDiastolicBloodPressureandDevelopmentofSymptomaticPeripheralArterialDiseaseintheWomen’sHealthStudy(WHS)

TiffanyM.Powell,RobertJ.Glynn,MarkA.Creager,PaulM.Ridker,ArunaD.PradhanHarvardMedicalSchoolBrighamandWomen’sHospitalTheauthorshavenoconflictsofinterestrelatedtothisresearch.UncontrolledHypertension,Sys1PeripheralArterialDiseaseIncreasingbutunder-diagnosedcardiovascularhealthissueAffectsupto29%ofAmericansHypertensionlinkedtoPADdevelopmentLackingdataonPADriskpredictionrelatedto:Systolicbloodpressure(SBP)Diastolicbloodpressure(DBP)Criqui,M.H.etal.VascMed2001,Murabito,J.M.etal.AmHeartJ2002PeripheralArterialDiseaseIn2UncontrolledHypertensionUptotwo-thirdsofAmericanswithhypertensionare:UntreatedUndertreatedControlofhypertensiontocurrentguidelinesreducescoronaryarterydiseaseby57%HowdoesbloodpressureandcontrolstatusrelatetoPADrisk?Wang,T.J.etal.,Circulation2005UncontrolledHypertensionUpto3【高血壓英文課件】惡性高血壓-Uncontrolled-Hypertension4【高血壓英文課件】惡性高血壓-Uncontrolled-Hypertension5StudyPopulation39,261WomenwithCompleteexposureData39,876Women515WomenMissingBaselineSBP534WomenMissingBaselineDBP51WomenMissingHistoryandTreatmentofHTNStudyPopulation39,261Womenw639,261WomenFreeofSymptomaticPADwithCompleteDataonBloodPressureWithoutHTNN=30300TreatedandControlledN=2679UntreatedandUncontrolledN=3494UndertreatedandUncontrolledN=2788WomenwithHTNUncontrolledHTNdefinedasreportedSBP>140mmHgand/orDBP>90mmHg,oronanti-hypertensivetherapy39,261WomenFreeofSymptomat7PADEventsinWHSSept2005–482self-reportedcasesofsymptomaticPADSymptomaticPADdefinedas:IntermittentclaudicationbasedonEdinburghClaudicationQuestionnaireDocumentedperipheralarterialsurgeryinclusiveofperipheralangioplastyorstenting116confirmedcasesofPADPADEventsinWHSSept2005–48StatisticalAnalysisContinuousBPvaluesassignedusingmid-pointofreportedBPcategory.CoxProportionalHazardsRegressionHazardRatiosforincidentPAD:AccordingtotreatmentandBPcontrolstatusSBP,DBP,MeanArterialPressure(MAP),PulsePressure(PP)per10mmHgandBPcategoriesGlobalmodelfitassessedbymodellog-likelihoodstatistics.StatisticalAnalysis9ModelsofPADRiskMultivariatemodelsadjustedfor:Age(logage)Smoking(never/past/current)Diabetes(no/yes)BMI(continuous)HistoryofElevatedCholesterol(no/yescholesterol>240mg/dl)PostmenopausalHTRandomizedtreatmentassignmentwithASA/VitEModelsofPADRiskMultivariate10BaselineCharacteristicsNoHTN(N=30300)TreatedandControlled(N=2679)Hypertensive(untreated)(N=3494)Hypertensive(undertreated)(N=2788)p-valueforTrendAge,yrs53.86.656.77.457.27.858.27.8<0.0001BMI,kg/m225.34.528.05.728.55.929.26.0<0.0001Hyperlipidemia,%7731(25.5)1203(44.9)1306(37.4)1373(49.3)0.04Diabetes,%496(1.6)191(7.1)182(5.2)305(10.9)0.003Smoker,%4097(13.4)310(11.6)447(12.8)323(11.6)<0.0001BaselineCharacteristicsNoHTN11BaselineCharacteristicsNormotensive(untreated)(N=30300)Normotensive(treated)(N=2679)Hypertensive(untreated)(N=3494)Hypertensive(undertreated)(N=2788)p-valueforTrendSBP,mmHg117.012.8129.67.2144.911.4147.59.8<0.0001DBP,mmHg73.88.981.75.988.07.489.26.9<0.0001MAP,mmHg88.29.297.75.3107.05.8108.65.8<0.0001PP,mmHg43.210.047.97.556.914.258.311.7<0.0001ValuesaremeanSD

BaselineCharacteristicsNormot12PADRiskbyTreatmentandControlStatusHazardRatioPfortrend<0.0001PADRiskbyTreatmentandCont13SBPLRT:184.23df:DBP00.51.01.52.0SBPandDBP169.61184.31PP177.50MAP178.21PPandMAP184.31HRforPADPer10mmHgincreaseinBPvariable101011101011MultivariableHRsAccordingto10mmHgIncreaseinBPSBPLRT:184.23df:DBP00.51.01.5214CategoriesofSystolicBloodPressurePforlineartrend<0.0001HazardRatioCategoriesofSystolicBloodP15CategoriesofBloodPressureBothSystolicandDiastolicBloodPressureSBPCategoriesAge-AdjustedMultivariable-Adjusted<120mmHg1.00(reference)1.00(reference)120–139mmHg1.66(0.97–2.84)1.66(0.95-2.89)140–159mmHg2.67(1.36-5.28)2.73(1.35-5.51)

160mmHg4.06(1.35-12.20)3.84(1.25-11.82)P,lineartrend0.0020.003DBPcategories<75mmHg1.00(reference)1.00(reference)75–84mmHg0.98(0.59-1.62)0.96(0.57-1.61)85–89mmHg0.87(0.46-1.67)0.95(0.49-1.84)

90mmHg1.10(0.53-2.28)1.16(0.55-2.44)P,lineartrend0.960.76CategoriesofBloodPressureBo16LimitationsSelf-reportedbloodpressuresubjecttomissclassificationFindingslimitedtosymptomaticdiseaseStudypopulationexclusivelycomprisedofwomenLimitationsSelf-reportedblood17ConclusionsUncontrolledhypertensionisassociatedwithincidentsymptomaticPADinwomen.WhileallbloodpressurevariablesassessedwereassociatedwithPADincidence,SBPwasthebestsinglepredictorinthisanalysis.Conclusi