摘要
目的探讨有妊娠期高血压疾病(HDP)病史女性的长时血压变异性与动脉硬化之间的关系。方法本研究为回顾性队列研究,数据来源于开滦研究数据库,纳入于1990年1月—2020年12月分娩并在产后完成臂踝脉搏波传导速度(baPWV)检测的有HDP病史的女性作为研究对象,收集分娩后首次健康体检资料作为基线数据,以最后一次体检时与血压测量同期进行的baPWV检测结果为结局指标。根据长时血压变异性水平,将入选研究对象按三分位数法由低至高分为第一分位组、第二分位组和第三分位组,比较各组临床特征差异。采用多因素logistic回归模型分析不同水平长时血压变异性对有HDP病史女性动脉硬化风险的影响。通过排除多次分娩史个体进行敏感性分析验证结果的稳健性,并基于分娩年龄(<40岁和≥40岁)及血压测量频次(3次和>3次)进行亚组分析,进一步探讨不同人群特征对研究结果的潜在影响。结果共纳入421例研究对象,年龄(36.07±6.05)岁,baPWV值为(1376.80±238.18)cm/s,长时血压变异性为4.66(3.41,6.50)mmHg(1 mmHg=0.133 kPa)。第一分位组140例,第二分位组141例,第三分位组140例。在总人群中,动脉硬化发生率为40.4%(170/421),上述各组的动脉硬化发生率依次为34.3%(48/140)、39.0%(55/141)和47.9%(67/140)。多因素logistic回归分析显示,长时血压变异性升高是有HDP病史女性发生动脉硬化的独立危险因素(OR=1.702,95%CI 1.018~2.844,P=0.043)。敏感性分析结果与主分析一致(OR=1.758,95%CI 1.044~2.959,P=0.034)。亚组分析进一步表明,在分娩年龄<40岁(OR=2.116,95%CI 1.153~3.885,P=0.016)和血压测量频次>3次(OR=1.894,95%CI 1.069~3.355,P=0.029)亚组中,长时血压变异性与动脉硬化风险的关联更显著。结论对于有HDP病史的女性群体,较高的长时血压变异性可能增加其动脉硬化的发生风险,且这一影响在年轻女性(分娩年龄<40岁)和高频次(>3次)血压测量者中更显著。应重视对其血压变异性的监测和管理,改善长期心血管健康预后。
ObjectiveTo explore the relationship between long-term blood pressure variability and arteriosclerosis in women with a history of hypertensive disorders in pregnancy(HDP).MethodsThis study was a retrospective cohort study.Data were obtained from the Kailuan Research Database.Women with a history of HDP who delivered between January 1990 and December 2020 and completed brachial-ankle pulse wave velocity(baPWV)measurement in the postpartum period were enrolled.Baseline data were obtained from the first post-delivery health examination,while the outcome measure was the baPWV recorded during the last follow-up visit,synchronized with blood pressure measurements.Based on long-term blood pressure variability,the enrolled study subjects were divided into the first,second,and third tertile groups in ascending order using the tertile method,and intergroup differences in clinical characteristics were compared.Multivariable logistic regression was performed to evaluate the impact of long-term blood pressure variability levels on arteriosclerosis risk in women with a history of HDP.Sensitivity analyses excluded individuals with multiple deliveries to validate the robustness of findings.Subgroup analyses were conducted based on delivery age(<40 vs.≥40 years)and blood pressure measurement frequency(3 vs.>3 times)to explore the potential impact of different population characteristics on the study results.ResultsA total of 421 study subjects were enrolled,aged(36.07±6.05)years,with a baPWV value of(1376.80±238.18)cm/s.Long-term blood pressure variability was 4.66(3.41,6.50)mmHg(1 mmHg=0.133 kPa).The first,second and third quartile group included 140,141 and 140 individuals,respectively.In the total population,the incidence of arteriosclerosis was 40.4%(170/421).The incidence rates in the first,second,and third tertile groups were 34.3%(48/140),39.0%(55/141),and 47.9%(67/140),respectively.Multivariate logistic regression analysis showed that increased long-term blood pressure variability was an independent risk factor for arteriosclerosis in women with a history of HDP(OR=1.702,95%CI 1.018-2.844,P=0.043).The results of sensitivity analyses were consistent with that of the primary analysis(OR=1.758,95%CI 1.044-2.959,P=0.034).Subgroup analyses further indicated that in the subgroups with delivery age<40 years(OR=2.116,95%CI 1.153-3.885,P=0.016)and blood pressure measurement frequency>3 times(OR=1.894,95%CI 1.069-3.355,P=0.029),the association between long-term blood pressure variability and arterial stiffness risk was more significant.ConclusionsFor women with a history of HDP,elevated long-term blood pressure variability may increase the risk of arteriosclerosis,and this effect is more pronounced in younger women(delivery age<40 years)and those with high-frequency blood pressure measurements(>3 times).Enhanced monitoring and management of blood pressure variability in this population are crucial to improving long-term cardiovascular health outcomes.
作者
屈春乐
杨宁
魏茂提
尹诗琦
陈朔华
吴寿岭
李玉明
Qu Chunle;Yang Ning;Wei Maoti;Yin Shiqi;Chen Shuohua;Wu Shouling;Li Yuming(Department of Hypertension,Teda International Cardiovascular Hospital,Tianjin University,Tianjin 300457,China;Department of Hypertension,Tianjin Kanghui Hospital,Tianjin 300385,China;Department of Medical,Teda International Cardiovascular Hospital,Tianjin University,Tianjin 300457,China;Department of Cardiology,Kailuan General Hospital,Tangshan 063000,China)
出处
《中华心血管病杂志》
北大核心
2025年第10期1112-1118,共7页
Chinese Journal of Cardiology
关键词
高血压
妊娠性
长时血压变异性
动脉硬化
心血管疾病
Hypertensive,pregnancy-induced
Long-term blood pressure variability
Arteriosclerosis
Cardiovascular diseases
