【摘要】 目的 探讨江苏省≥60岁老年高血压患者收缩压（SBP）目标范围内时间（time in target range, TTR）与脑卒中死亡风险的关联，为优化老年高血压患者管理提供参考依据。方法 基于2016年江苏省心血管病高危人群早期筛查与综合干预项目招募人群，纳入2017—2019年至少有2次年度长期随访记录的年龄≥60岁高血压患者为研究对象。SBP的目标范围定义为120～140 mmHg,采用Rosendaal线性插值法计算SBP-TTR,根据SBP-TTR水平将研究对象分为T1组（SBP-TTR=0）、T2组（SBP-TTR<38.1%）和T3组（SBP-TTR≥38.1%）。利用江苏省死亡登记系统获取研究对象死亡信息。使用多因素Cox比例风险回归模型，分析不同SBP-TTR组与脑卒中及其亚型死亡的风险比（hazard ratios,HR）及其95%CI。结果 共纳入6 876例患者，中位随访时长6.13年，记录脑卒中死亡事件150例，其中缺血性脑卒中100例，出血性脑卒中50例。多因素Cox比例风险回归模型显示，在额外调整基线SBP等因素的模型3情况下，以T1组为参照，T3组脑卒中（HR=0.49,95%CI:0.30～0.82）、缺血性脑卒中（HR=0.51,95%CI:0.27～0.94）死亡风险均降低（P值均<0.05）,与出血性脑卒中死亡风险未见统计学关联（HR=0.46,95%CI:0.19～1.11,P>0.05）;SBP-TTR每增加1个标准差，老年高血压患者脑卒中死亡风险降低25%（HR=0.75,95%CI:0.60～0.94,P<0.05）,缺血性脑卒中和出血性脑卒中死亡风险HR（95%CI）分别为0.78（0.60～1.02）和0.69（0.47～1.03）,未见统计学关联（P值均>0.05）。分层分析结果显示，SBP-TTR与性别、年龄、吸烟状况、饮酒状况均未发现交互作用(P_交互值均>0.05)。结论 老年高血压患者较高的SBP-TTR可能与脑卒中死亡风险降低相关。更多还原

【Abstract】 Objective To explore the correlation between time in target range(TTR) of systolic blood pressure(SBP) and stroke mortality risk among elderly hypertensive patients aged ≥ 60 years in Jiangsu Province, so as to provide references for optimizing the management of elderly hypertensive patients. Methods Based on the population recruited from the 2016 Jiangsu Province early screening and comprehensive intervention project for high-risk cardiovascular disease populations, hypertensive patients aged ≥ 60 years with at least two annual long-term follow-up records from 2017 to 2019 were included as the research subjects.The target range of SBP was defined as 120-140 mmHg, and the Rosendaal linear interpolation method was used to calculate SBP-TTR.Based on the SBP-TTR level, the research subjects were divided into Group T1(SBP-TTR=0),Group T2(SBP-TTR<38.1%) and Group T3(SBP-TTR ≥ 38.1%).Mortality information of research subjects was obtained from the Jiangsu Provincial Death Registration System.A multivariate Cox proportional hazards regression model was used to analyze the hazard ratios(HR) and 95% CI of different SBP-TTR groups with respect to stroke and its subtypes of mortality. Results A total of 6 876 patients were included, with a median follow-up duration of 6.13 years.During follow-up, 150 cases of stroke-related deaths were recorded, including 100 cases of ischemic stroke and 50 cases of hemorrhagic stroke.The multivariate Cox proportional hazards regression model showed that, after additional adjustments for baseline SBP and other factors in Mode 3,compared with Group T1,Group T3 demonstrated a reduced risk of death from stroke(HR=0.49,95%CI:0.30-0.82) and ischemic stroke(HR=0.51,95%CI:0.27-0.94)(P<0.05 in both cases),but no statistically significant association was observed with the risk of death from hemorrhagic stroke(HR=0.46,95%CI:0.19-1.11,P>0.05).For each one-standard-deviation increase in SBP-TTR,the risk of stroke mortality in elderly hypertensive patients decreased by 25%(HR=0.75,95%CI:0.60-0.94,P<0.05).The HRs(95%CI) for ischemic stroke and hemorrhagic stroke mortality were 0.78(0.60-1.02) and 0.69(0.47-1.03) respectively, with no statistically significant association observed(P>0.05 in all cases).The stratified analysis results showed that there were no significant interaction effects between SBP-TTR and gender, age, smoking, or alcohol consumption(P interaction values>0.05). Conclusions A higher SBP-TTR in elderly hypertensive patients may be correlated with a lower stroke mortality risk.更多还原