收缩压目标范围内时间与左心室增大的关系

Relationship between time in target range for systolic blood pressure and left ventricular enlargement

摘要

目的 评估收缩压目标范围内时间（SBP-TTR）与左心室增大的关系。方法 对来自开滦研究的 33 907 名参与者进行分析，他们完成了 2006—2020 年度至少两次健康体检和末次体检后的超声心动图检查。使用线性插值法计算 SBP-TTR，收缩压的目标范围分别设定为标准目标（120～140 mmHg）和强效目标（110～130 mmHg）。根据 SBP-TTR 的四分位数，将参与者分为四组。采用泊松回归模型评估 SBP-TTR 与左心室增大的关系。采用限制性立方样条可视化 SBP-TTR 与左心室增大风险的剂量-反应关系。结果 收缩压目标范围为标准目标时，SBP-TTR 0%～25%、＞25%～50%、＞50%～75%、＞75%～100% 组左心室增大比例分别为 14.10%（1 962/13 916）、10.40%（683/6 565）、9.38%（586/6 250）、9.99%（717/7 176），4 组比较，差异有统计学意义（χ² = 141.628，P＜0.001）。校正混杂因素后，泊松回归分析显示：当收缩压的目标范围为标准目标时，与 SBP-TTR 为 0～25% 组相比，其他三组的左心室增大风险逐渐降低（P_趋势 = 0.008），RR（95%CI）值分别为 0.99（0.90～1.08）、0.92（0.84～1.02）和 0.89（0.82～0.98），SBP-TTR 每增加一个标准差，左心室增大风险降低 4%（RR = 0.96，95%CI：0.93～0.99）。当收缩压的目标范围为强效目标时，与 SBP-TTR 为 0～25% 组参与者相比，其他三组的左心室增大风险仍逐渐降低（P_趋势＜0.001），RR（95%CI）值分别为 0.95（0.86～1.05）、0.86（0.77～0.96）和 0.72（0.65～0.80）；SBP-TTR 每增加一个标准差，左心室增大风险降低 11%（RR = 0.89，95%CI：0.85～0.92）。校正基线收缩压和传统危险因素后，SBP-TTR 与左心室增大的关联依然有统计学意义。结论 SBP-TTR 与左心室增大呈负相关，并且强效降压效果更显著。

Abstract

Objective To assess the association between time in target range for systolic blood pressure (SBP-TTR) and left ventricular enlargement. Methods A total of 33 907 participants from the Kailuan Study who completed at least two health check-ups between 2006 and 2020 and underwent echocardiography after their last check-up were analyzed. The SBP-TTR was calculated using the linear interpolation method, with the target ranges of systolic blood pressure (SBP) set as the standard target (120 to 140 mmHg) and the intensive target (110 to 130 mmHg), respectively. Participants were divided into four groups according to the quartiles of SBP-TTR. Poisson regression model was used to investigate the association between SBP-TTR and left ventricular enlargement. Restricted cubic splines were used to visualize the dose-response relationship between SBP-TTR and the risk of left ventricular enlargement. Results When the target range of SBP was the standard target, the proportions of left ventricular enlargement in the SBP-TTR 0% to 25%, ＞ 25% to 50%, ＞ 50% to 75%, and ＞ 75% to 100% groups were 14.10% (1 962/13 916), 10.40% (683/6 565), 9.38% (586/6 250), and 9.99% (717/7 176), respectively. A comparison among the four groups showed statistically significant differences (χ² = 141.628, P＜0.001). After adjusting for confounding factors, Poisson regression analysis showed that when the target range of SBP was the standard target, compared with the group with SBP-TTR of 0 to 25%, the risk of left ventricular enlargement in the other three groups gradually decreased ( P for trend = 0.008), with RR (95%CI) values of 0.99 (0.90 to 1.08), 0.92 (0.84 to 1.02), and 0.89 (0.82 to 0.98); SBP-TTR per 1-SD increase was associated with a 4% lower risk of left ventricular enlargement (RR = 0.96, 95%CI: 0.93 to 0.99). When the target range of SBP was the intensive target, compared with the group with SBP-TTR of 0 to 25%, the risk of left ventricular enlargement in the other three groups still gradually decreased (P for trend ＜ 0.001), with RR (95%CI) values of 0.95 (0.86 to 1.05), 0.86 (0.77 to 0.96), and 0.72 (0.65 to 0.80); SBP-TTR per 1-SD increase was associated with an 11% lower risk of left ventricular enlargement (RR = 0.89, 95%CI: 0.85 to 0.92). After adjusting for baseline systolic blood pressure and traditional risk factors, the association between SBP-TTR and left ventricular enlargement remained statistically significant. Conclusion SBP-TTR is negatively correlated with left ventricular enlargement, and the intensive antihypertensive effect is more significant.

关键词

收缩压 / 目标范围内时间 / 左心室增大

Key words

systolic blood pressure / time in target range / left ventricular enlargement

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