非高血压人群臂踝动脉脉搏波传导速度与血压的纵向关系

The bidirectional longitudinal association between brachial-ankle pulse wave velocity and blood pressure in non-hypertensive population

摘要

目的 分析非高血压人群不同血压指标与臂踝动脉脉搏波传导速度（baPWV）之间的双向纵向关系。方法 对2015-2022年至少2次来上海市保健医疗中心参加健康体检的体检者资料进行分析。采用logistic回归分析基线baPWV对新发高血压的影响，并用受试者工作特征（ROC）分析、Delong检验比较不同预测模型。采用线性混合模型分析平均动脉压、收缩压、舒张压、脉压与baPWV的双向纵向关系。结果 收集到满足条件的1 873名非高血压人群资料。男性1 384人（73.9%），女性489人（26.1%），年龄23～86岁，平均年龄（47.3±8.5）岁，随访时间间隔（3.4±0.2）年。按基线baPWV进行三分位分组，低分位组628例、中分位组623例、高分位组622例。Logistic回归分析提示，baPWV独立于其他传统心血管危险因素影响高血压的新发，以低分位组为参照，中分位组和高分位组新发高血压OR值分别为1.897（95%CI：1.075～3.347）、3.189（95%CI：1.851～5.495）。基线baPWV预测新发高血压的研究中，基线血压指标同时纳入收缩压和舒张压的模型对应的Akaike的信息条件（AIC）值最低，ROC曲线下面积最大，为0.810（95%CI：0.780～0.839）。Delong检验分析显示，基线血压同时纳入收缩压和舒张压的模型与未纳入基线血压模型、只纳入基线舒张压模型比较，差异有统计学意义（P＜0.05）。对1 821例始终未服降压药者进行线性混合模型分析，分别校正了各自基线值、年龄等影响因素后，基线baPWV对随诊收缩压、随诊舒张压、随诊平均动脉压和随诊脉压均有影响，β值分别为0.181（95%CI：0.139～0.223）、0.137（95%CI：0.089～0.185）、0.151（95%CI：0.103～0.199）、0.111（95%CI：0.060～0.161）；基线收缩压、基线舒张压、基线平均动脉压和基线脉压对随诊baPWV也有影响，估计值分别为0.056（95%CI：0.025～0.087）、0.040（95%CI：0.010～0.071）、0.054（95%CI：0.022～0.085）、0.031（95%CI：0.002～0.060）。按性别和年龄分组，亚组分析中收缩压与baPWV间的相互影响持续存在（P＜0.05）。结论 非高血压人群baPWV与收缩压存在双向纵向相关。baPWV预测新发高血压时，基线血压指标同时纳入收缩压和舒张压的模型预测效果可能更佳。

Abstract

Objective To analyze the bidirectional longitudinal relationship between blood pressure and brachial-ankle pulse wave velocity (baPWV) in non-hypertensive populations. Methods Analyze the data of individuals who underwent check-ups in Shanghai Health and Medical Center at least twice from 2015 to 2022. Use logistic regression analysis to assess the impact of baseline baPWV on patients with newly diagnosed hypertension, and use receiver operating characteristic curve (ROC) analysis and Delong test to compare the predictive performance of different prediction models. Use a linear mixed model to analyze the bidirectional longitudinal relationship between mean arterial pressure, systolic blood pressure, diastolic blood pressure, pulse pressure and baPWV. Results The data of 1 873 non-hypertensive individuals who met the criteria were collected, including 1 384 males (73.9%) and 489 females (26.1%), aged between 23 and 86 years, with an average age of (47.3±8.5) years, and the follow-up time interval was (3.4±0.2) years. Grouped by tertiles of baseline baPWV, there were 628 cases in the low tertile group, 623 cases in the middle tertile group, and 622 cases in the high tertile group. Logistic regression analysis indicated that baPWV independently affected the incidence of hypertension regardless of other traditional cardiovascular risk factors. Compared with the low tertile group, the OR values for incident hypertension in the middle and high tertile groups were 1.897 (95%CI: 1.075-3.347) and 3.189 (95%CI: 1.851-5.495), respectively. In the study of baseline baPWV predicting incident hypertension, the model incorporating both systolic and diastolic blood pressure as baseline indicators had the lowest Akaike information criterion (AIC) value and the largest area under the ROC curve, which was 0.810 (95%CI: 0.780-0.839). Delong test analysis showed that the model incorporating both systolic and diastolic blood pressure had statistically significant differences compared with the model without baseline blood pressure and the model with only baseline diastolic blood pressure (P<0.05). Linear mixed model analysis was performed on 1 821 individuals who never took antihypertensive drugs. After adjusting for respective baseline values, age and other influencing factors, baseline baPWV had effects on follow-up systolic blood pressure, follow-up diastolic blood pressure, follow-up mean arterial pressure and follow-up pulse pressure, withβ values of 0.181 (95%CI: 0.139-0.223), 0.137 (95%CI: 0.089-0.185), 0.151 (95%CI: 0.103-0.199), and 0.111 (95%CI: 0.060-0.161), respectively; baseline systolic blood pressure, baseline diastolic blood pressure, baseline mean arterial pressure and baseline pulse pressure also had effects on follow-up baPWV, with estimated values of 0.056 (95%CI: 0.025-0.087), 0.040 (95%CI: 0.010-0.071), 0.054 (95%CI: 0.022-0.085), and 0.031 (95%CI: 0.002-0.060), respectively. Grouped by gender and age, subgroup analysis showed that the mutual influence between systolic blood pressure and baPWV persisted (P<0.05). Conclusion There is a bidirectional longitudinal correlation between baPWV and systolic blood pressure in non-hypertensive population. When baPWV predicts incident hypertension, the model incorporating both systolic and diastolic blood pressure as baseline indicators may have better predictive performance.

关键词

动脉硬化 / 臂踝动脉脉搏波传导速度 / 血压

Key words

arterial stiffness / brachial-ankle pulse wave velocity / blood pressure

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基金资助

上海市保健医疗中心（华东疗养院）重点课题(2020001)

上海市卫生健康委员会面上课题(202340142)