血压和临床事件的风险在周围动脉疾病
Saket Girotra1, Mary Vaughan-Sarrazin2, James A de Lemos3
1University of Texas Southwestern Medical Center, North Texas Veterans Affairs Medical Center, Dallas, TX.
medRxiv : the preprint server for health sciences
|November 19, 2025
概括
目前对外围动脉疾病 (PAD) 的血压指南可能会增加四肢事件的风险. 降低血压 (BP) 过多可能会损害四肢输液,这表明需要修订PADBP目标.
科学领域:
- 心血管医学 心血管医学
- 血管外科 血管外科
- 高血压研究 高血压研究
背景情况:
- 目前的指导方针建议在周围动脉疾病 (PAD) 患者的血压 (BP) 目标为≤130/80 mm Hg.
- 很少有PAD患者被纳入具有里程碑意义的降血压试验,并没有评估四肢事件.
- 密集的血压控制可能会对PAD患者的肢体输液产生负面影响.
研究的目的:
- 为了评估纵向血压值与美国退伍军人患有PAD的心血管和四肢事件风险之间的关联.
- 确定当前的血压指南是否对PAD患者来说是最佳的,同时考虑心血管和四肢的结果.
主要方法:
- 利用了从2015年至2020年期间诊断出PAD的91,296名美国退伍军人纵向注册表的数据.
- 采用多变量考克斯回归模型,将时间变化的BP作为暴露.
- 对心血管事件 (心肌梗塞,中风) 和肢体事件 (慢性肢体威胁性缺血症,重大截肢) 的评估风险.
主要成果:
- 较高的静脉血压 (≥140毫米升) 与心血管事件风险增加有关.
- 系统性血压和四肢事件之间的关联是U形,在低 (<110毫米升) 和高 (≥160毫米升) 水平时风险增加.
- 这种不一致性在患有糖尿病和严重PAD的患者中更加明显.
结论:
- 目前针对PAD的BP建议优化了心血管风险,但可能会增加四肢事件风险.
- 对于PAD患者,特别是那些容易发生四肢事件的患者,有必要重新定义血压目标.
- 对PAD患者来说,可能需要个性化BP管理策略,以平衡心血管和四肢 perfusion 风险.
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