摘要
目的 探讨高血压病史及基线血压水平对心房颤动（房颤）患者主要心血管事件（心血管死亡、卒中、心肌梗死和非中枢神经系统栓塞发生）的影响.方法 2008年11月至2011年10月在全国20家医院连续入选急诊就诊的所有房颤患者,无论是否为急诊就诊的主要原因均可入选.记录患者的基线资料、治疗情况;并进行1年随访,记录主要心血管事件（包括心血管死亡、卒中、心肌梗死和非中枢神经系统栓塞事件的发生情况）.按照患者既往高血压病史分成二组：高血压病史组和无高血压病史组.应用单变量Cox分析分别评价高血压病史、基线血压水平对主要心血管事件的影响;用多变量Cox回归分析模型识别主要心血管事件发生的预测因素.结果 本研究共纳入2016例房颤患者,全部患者平均收缩压/舒张压分别为（131.9±23.3）/（79.9±14.7）mm Hg（1 mm Hg=0.133 kPa）;既往高血压病史的患者有1118例（55.5％）,其中在高血压患者中,接受抗高血压治疗的比例高达91.1％.1年随访时的主要心血管事件发生共314例（15.6％）,其中高血压病史组191例（17.1％）,无高血压病史组123例（13.7％）.对主要心血管事件作单变量Cox回归分析的结果显示,患者既往高血压病史、基线收缩压水平（连续变量）是1年随访主要心血管事件发生的危险因素（HR=1.269,95％ CI：1.012～1.592,P=0.039;HR=1.005,95％CI：1.000 ～1.010,P=0.042）,而基线舒张压水平（连续变量）无统计学意义（HR=0.998,95％CI：0.991 ～1.006,P=0.698）.多变量Cox回归模型校正其他因素后,高血压病史分组及基线收缩压水平、舒张压水平对1年主要心血管事件的发生并不具有独立预测价值.此外,多变量Cox回归模型分析显示年龄、心力衰竭史、卒中史是房颤患者1年随访主要心血管事件发生的独立预测因素.结论 年龄、心力衰竭史、卒中史是房颤患者1年随访发生主要心血管事件的预测因素.
Objective To explore the impact of hypertension history and baseline blood pressure levels on cardiovascular outcomes in Chinese emergency atrial fibrillation patients during 1 year follow- up. Methods This prospective study consecutively enrolled patients presenting to an emergency department with atrial fibrillation from 20 hospitals in China during November 2008 to October 2011. Baseline data and treatment regimen were recorded, all patients were followed up for one year, and major cardiovascular events （MACE including cardiovascular death, stroke, myocardial infarction, and non central nervous systemic embolism）were recorded. Patients were divided into hypertension history group and non-hypertension history group. Univariate Cox analysis was evaluated hypertension history, baseline blood pressure on major cardiovascular events. Multivariate Cox analysis recognized risk factors for major cardiovascular events. Results A total of 2016 atrial fibrillation patients were enrolled, and the average systolic blood pressure and diastolic blood pressure were （ 131.9 -＋ 23.3） mm Hg（ 1 mm Hg = 0. 133kPa）, （79. 9 ＋ 14. 7） mm Hg respectively. 1118 patients （55.5%） had a history of hypertension, and about 91.1% hypertension patient received antihypertensive treatment. Major cardiovascular events occurred in 314 cases （ 15.6% ） among 1 year follow up, and 191 cases （ 17. 1% ） among hypertension group and 123 cases （ 13.7% ） among non-hypertension group. Univariate Cox regression analysis of prognostic factors for major cardiovascular events showed that hypertension history and baseline systemic blood pressure were risk factors （HR=1.269, 95%CI： 1.012-1.592, P=0.039; HR =1.005, 95% CI- 1.000- 1.010, P=0.042）. Multivariate Cox regression model analysis, adjusted others risk factors, showed that hypertension history, baseline systolic pressure levels, and baseline diastolic blood pressure did not have independent predictive value for major cardiovascular events. Moreover, multivariate Cox regression analysis showed that age, history of heart failure, history of stroke were independent prognostic factor for one year follow-up of major cardiovascular events in atrial fibrillation patients. Conclusion Age, history of heart failure, history of stroke were independent predictor for 1 year major cardiovascular events in Chinese emergency atrial fibrillation patients.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2013年第11期911-915,共5页
Chinese Journal of Cardiology
关键词
心房颤动
血压
心血管事件
Atrial fibrillation
Blood pressure
Cardiovascular events
