Objective: To investigate the impact of different levels of systolic blood pressure on all-cause, cardiovascular and cerebrovascular mortality in patients with nonvalvular atrial fibrillation (AF). Methods: This is a prospective cohort study. Patients with AF or atrial flutter diagnosed by 12 lead electrocardiogram during physical examination of Kailuan Group employees from July 2006 to December 2017 or previously diagnosed with AF in an inpatient setting at a level 2A hospital or above were eligible for the study. Baseline clinical characteristics including age, gender, systolic blood pressure were collected. According to the level of systolic blood pressure, patients were divided into systolic blood pressure<120 mmHg (1 mmHg=0.133 kPa)group, 120 mmHg ≤ systolic blood pressure<140 mmHg group, and systolic blood pressure ≥140 mmHg group. The time of first diagnosis with AF was defined as the start of follow-up and the final follow-up ended at December 2018. Primary endpoint was all-cause death. Related information was obtained through the social security system or inpatient medical records. The cause of death was defined according to the International Classification of Diseases disease (ICD-10) codes by professional medical stuffs. Multifactorial Cox proportional risk model was used to analyze the relative risk ratios for the occurrence of death in different systolic blood pressure level groups. The relationship between systolic blood pressure levels and mortality in the patients with AF was analyzed by using natural spline function curves. Results: A total of 1 721 patients with AF were enrolled (average age=(67.0±9.0) years), patients were followed up for (6.3±3.8) years. 544 out of 1 721 patients with AF died during the follow-up period (31.61%). The cumulative incidence rate of all-cause mortality, cardiovascular and cerebrovascular death was 26.13%, 25.59%, 36.96% and 14.86%, 11.87%, 19.76% respectively in the systolic blood pressure<120 mmHg, 120 mmHg ≤ systolic blood pressure<140 mmHg and systolic blood pressure ≥140 mmHg groups. The cumulative incidence rate of all-cause, cardiovascular and cerebrovascular death was significantly higher in the group with systolic blood pressure ≥140 mmHg than in 120 mmHg ≤ systolic blood pressure<140 mmHg group (P<0.05). Compared with 120 mmHg ≤ systolic blood pressure<140 mmHg group, multivariable Cox proportional hazards regression models showed that the HRs (95%CI) for all-cause, cardiovascular and cerebrovascular death were 1.47 (1.20 to 1.79) and 1.69 (1.27 to 2.26) for the group with systolic blood pressure ≥ 140 mmHg (P<0.05). In contrast, the HRs (95%CI) for all-cause, cardiovascular and cerebrovascular death in the systolic blood pressure<120 mmHg group were 0.99 (0.73-1.35) and 1.24 (0.82-1.89), respectively, with no statistically significant differences between the two groups (P>0.05). The natural spline curve showed that there was a "U" relationship between systolic blood pressure levels and all cause death and cardiovascular and cerebrovascular death in this patient cohort. Systolic blood pressure greater than or less than 123 mmHg was associated with increased risk of death of AF patients in this cohort. Conclusion: Compared with systolic blood pressure<120 mmHg and systolic blood pressure≥140 mmHg group, the risk of all-cause and cardiovascular and cerebrovascular death is the lowest in AF patients with 120 mmHg ≤ systolic blood pressure<140 mmHg in this cohort.
目的： 探讨不同收缩压水平对非瓣膜性心房颤动（房颤）患者全因、心脑血管疾病死亡的影响。 方法： 本研究为前瞻性队列研究。选取参加2006年7月—2017年12月开滦集团职工健康体检时心电图诊断为房颤或此前在二级甲等以上医院住院诊断为房颤的患者，收集其年龄、性别、收缩压等基线临床资料，根据其收缩压水平分为收缩压<120 mmHg（1 mmHg=0.133 kPa）组、120 mmHg≤收缩压<140 mmHg组、收缩压≥140 mmHg组。以首次确诊房颤时间为起点，对房颤患者进行死亡信息随访，通过社保系统获取死亡信息，由专业医务人员调取住院病历，并根据国际疾病分类（ICD）-10疾病编码确定死因，至2018年12月随访结束。统计不同收缩压水平组全因、心脑血管、心血管和脑血管疾病死亡累积发生率，并采用多因素Cox比例风险模型分析不同收缩压水平组发生死亡的风险比。采用自然样条函数曲线判断房颤人群的收缩压水平与其死亡的函数曲线类型。 结果： 共纳入1 721例房颤患者，年龄为（67.0±9.0）岁，随访（6.3±3.8）人年，随访期间有544例房颤患者死亡，全因累积死亡发生率为31.61%。收缩压<120 mmHg、120 mmHg≤收缩压<140 mmHg、收缩压≥140 mmHg组全因累积死亡发生率分别为26.13%、25.59%、36.96%，心脑血管疾病累积死亡发生率14.86%、11.87%、19.76%。收缩压≥140 mmHg组全因、心脑血管疾病累积死亡发生率高于120 mmHg≤收缩压<140 mmHg组，差异有统计学意义（P<0.05）；与120 mmHg≤收缩压<140 mmHg组相比，收缩压≥140 mmHg组全因、心脑血管疾病死亡HR值（95%CI）分别为1.47（1.20~1.79）、1.69（1.27~2.26），差异均有统计学意义（P均<0.05）。收缩压<120 mmHg组全因、心脑血管疾病死亡HR值（95%CI）分别为0.99（0.73~1.35）、1.24（0.82~1.89），差异无统计学意义（P>0.05）；房颤人群的收缩压水平与其发生全因、心脑血管疾病死亡的自然样条函数曲线呈“U”型，收缩压水平大于或小于123 mmHg均增加房颤患者的死亡风险。 结论： 与收缩压<120 mmHg和收缩压≥140 mmHg组相比，120 mmHg≤收缩压<140 mmHg水平的房颤人群发生全因、心脑血管疾病死亡风险最低。.