2018年6月5日，中国疾病预防控制中心环境与健康相关产品安全所施小明研究团队在国际知名学术期刊《The BMJ》上发表题为“Revisiting the association of blood pressure with mortality in oldest old people in China:community based, longitudinal prospective study”的论著，重新审视了高龄老人血压与死亡风险之间的关系，在高龄老人的血压管理及风险控制方面具有重要意义。
该研究探讨了中国高龄老人血压与三年全因死亡风险和死因别死亡风险之间的关系，发现收缩压（SBP）与死亡风险为U型关系，死亡风险最低点的SBP为129mmHg，高SBP意味着更高的心血管疾病死亡风险，低SBP意味着更高的非心血管疾病死亡风险。
在中年人或低龄老年人中，高血压和低血压已被确认为疾病和生存的危险因素，但这种关联关系随着年龄增长而逐步减弱。80岁以上高龄老人是中国人群中数量增长最快的群体，在这一年龄组探究血压与全因死亡风险和死因别死亡风险是否存在关联极具现实意义，特别是如何识别高龄老人的死亡风险最低的血压值或血压范围。
施小明团队基于中国疾病预防控制中心与北京大学联合实施的中国老年健康影响因素跟踪调查（CLHLS）第六次（2011）调查4658名高龄老人的相关数据分析发现，在调整了混杂因素后，SBP与死亡风险为U型关系，死亡风险最低点为129mmHg。SBP低于107 mmHg时，死亡风险随SBP的升高而降低；SBP高于154 mmHg时，死亡风险随SBP的升高而增加；与中等水平（107~154 mmHg）的SBP组相比，低、高SBP组的高龄老人死亡风险均显著升高。
在死因别分析中，与中等水平的SBP（107~154mmHg）相比，高水平的SBP（＞154 mmHg）的高龄老人心血管疾病死亡风险升高51%，非心血管疾病死亡风险无显著变化；低水平的SBP（＜107 mmHg）的高龄老人非心血管疾病死亡风险升高58%，心血管疾病死亡风险无显著变化。上述结果，一定程度上合理解释了SBP与全因死亡风险的U型关系。
施小明团队在此项以社区为基础的中国高龄老人前瞻性大型队列研究中综合考虑心血管事件和非心血管事件，首次识别出高龄老人死亡风险最低的SBP值、具有较低死亡风险的SBP范围（107—154mmHg），阐明了形成U型曲线的科学解释。研究结果提示目前普遍采用的“关注高血压和心血管事件”的血压管理理念可能并不适用于高龄老人，而在制定公共卫生政策时需要根据80岁以上高龄老人的特殊性制定其独特的血压管理指南，从而更好地开展高龄老人血压相关疾病的防控工作，降低死亡风险，促进健康长寿。临床医生和相关研究人员也应注意，80岁以上高龄老人的“正常”血压范围可能有待重新探讨，对这一年龄段的人群应审慎地、个体化地开展高血压诊断和治疗。该文对高龄老人疾病防控和健康促进具有重要意义，为相关公共卫生政策的制定提供了参考依据。
惩罚样条Cox模型中血压与全因死亡风险之间的关系
原文出处：Lv, YB, Gao X, Yin ZX, Chen HS, Luo JS, Brasher MS, Kraus VB, Li TT, Zeng Y, Shi XM*. Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study. BMJ2018;361:k2158.DOI: https://doi.org/10.1136/bmj.k2158 (Published 05 June 2018) Correspondence to: X-M Shi shixm@chinacdc.cn
To examine the associations of blood pressure with all cause mortality and cause specific mortality at three years among oldest old people in China.
Community based, longitudinal prospective study.
2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey, conducted in 22 Chinese provinces.
4658 oldest old individuals (mean age 92.1 years).
All cause mortality and cause specific mortality assessed at three year follow-up.
1997 deaths were recorded at three year follow-up. U shaped associations of mortality with systolic blood pressure, mean arterial pressure, and pulse pressure were identified; values of 143.5 mm Hg, 101 mm Hg, and 66 mm Hg conferred the minimum mortality risk, respectively. After adjustment for covariates, the U shaped association remained only for systolic blood pressure (minimum mortality risk at 129 mm Hg). Compared with a systolic blood pressure value of 129 mm Hg, risk of all cause mortality decreased for values lower than 107 mm Hg (from 1.47 (95% confidence interval 1.01 to 2.17) to 1.08 (1.01 to 1.17)), and increased for values greater than 154 mm Hg (from 1.08 (1.01 to 1.17) to 1.27 (1.02 to 1.58)). In the cause specific analysis, compared with a middle range of systolic blood pressure (107-154 mm Hg), higher values (>154 mm Hg) were associated with a higher risk of cardiovascular mortality (adjusted hazard ratio 1.51 (95% confidence interval 1.12 to 2.02)); lower values (<107 mm Hg) were associated with a higher risk of non-cardiovascular mortality (1.58 (1.26 to 1.98)). The U shaped associations remained in sensitivity and subgroup analyses.
This study indicates a U shaped association between systolic blood pressure and all cause mortality at three years among oldest old people in China. This association could be explained by the finding that higher systolic blood pressure predicted a higher risk of death from cardiovascular disease, and that lower systolic blood pressure predicted a higher risk of death from non-cardiovascular causes. These results emphasise the importance of revisiting blood pressure management or establishing specific guidelines for management among oldest old individuals.