Association Of Blood Pressure With Cardiovascular Outcomes & Association Of Low-density Lipoprotein Cholesterol With Intracerebral Hemorrhage In The Elderly Patients With Hypertension

Ⅰ Association of Blood Pressure with Cardiovascular Outcomes in the Elderly Patients with HypertensionObjective The aim of this study was to investigate the association of systolic blood pressure（SBP）with cerebral infarction,intracerebral hemorrhage,myocardial infarction,and all-cause mortality.Methods In this cohort study,based on the Kailuan Study population,9655 elderly hypertensive patients were followed up with the incidence of primary outcomes（stroke and composite outcomes including myocardial infarction,stroke,and all-cause death）and the incidence of secondary outcomes（cerebral infarction,intracerebral hemorrhage,myocardial infarction,and all-cause death）.A risk score system,developed specifically for the Chinese population,was used to determine the risks of developing ICVD over a 10-year period.Cox proportional hazards model was used to analyze hazard ratios（HRs）with the corresponding 95%confidence interval（CI）of outcomes in different SBP groups and the different risks groups of developing ICVD over a 10-year period.Results During an average of 8.7±1.6 years of follow-up,（1）based on the current diagnostic criteria of hypertension,the patients were categorized into four groups（SBP<140mm Hg Q₁、140≤SBP<150mm Hg Q₂、150≤SBP<160mm Hg Q₃、≥160mm Hg Q₄）,the incidence rate was the lowest for composite outcome in the SBP<140mm Hg（Q1）group respectively.Compared to the Q1 group,the multivariate Cox proportional hazard regression model showed a hazard ratio[HR（95%CI）]in the SBP≥160mm Hg（Q4）group of 1.30（1.03-1.62）,1.17（1.05-1.32）for composite outcomes and cerebral infarction,and 1.31（1.03-1.68）,1.99（1.28-3.09）,1.12（1.00-1.27）for secondary outcomes like cerebral infarction,myocardial infarction,and all-cause death.Compared to the Q1 group,the[HR（95%CI）]was 0.84（0.73-0.98）,1.17（1.01-1.36）and 1.30（1.07-1.58）for composite outcomes in very low risk+low risk group,moderate risk group,and high risk+very high risk group,respectively,for incidence of 10-year ICVD in the Q3 group.the[HR（95%CI）]was 1.44（1.07-1.93）for stroke in moderate risk group for incidence of 10-year ICVD in the Q3 group.The[HR（95%CI）]was 0.74（0.64-0.86）,1.17（1.01-1.35）and 1.42（1.18-1.71）for composite outcomes in very low risk+low risk group,moderate risk group,and high risk+very high risk group,respectively,for incidence of 10-year ICVD in the Q2group.（2）Based on the the new arterial hypertension guidelines by the 2017American College of Cardiology（ACC）/American Heart Association（AHA）,the patients were categorized into five groups（SBP<130mm Hg Q_c、130≤SBP<140mm Hg Q_d、140≤SBP<150mm Hg Q₂、150≤SBP<160mm Hg Q₃、≥160mm Hg Q₄）,compared with reference group 130≤SBP<140mm Hg（Qd）,the[HR（95%CI）]was2.21（1.17-4.17）,for myocardial infarction in the Q3 group.The[HR（95%CI）]was1.16（1.01-1.33）,1.39（1.05-1.85）,1.52（1.10-2.09）and 2.52（1.36-4.66）for composite outcomes,stroke,cerebral infarction,myocardial infarction in Q4 group.The[HR（95%CI）]was 0.74（0.62-0.87）and 1.41（1.16-1.72）for composite outcomes in very low risk+low risk group and high risk+very high risk group,respectively,for incidence of 10-year ICVD in the Q2 group.The[HR（95%CI）]was 1.55（1.11-2.16）for stroke in moderate risk group for incidence of 10-year ICVD in the Q3 group.The[HR（95%CI）]was 1.19（1.01-1.42）and 1.32（1.07-1.63）for composite outcomes in moderate risk group,and high risk+very high risk group,respectively,for incidence of 10-year ICVD in the Q3 group.Compared with reference group SBP<130mm Hg（Qc）,the[HR（95%CI）]was 1.19（1.00-1.42）,1.39（1.01-1.48）for composite outcomes and all-cause death in Q4 group.The[HR（95%CI）]was 1.29（1.02-1.64）for composite outcomes in high risk+very high risk group in the Q3 group.The[HR（95%CI）]was 0.75（0.61-0.91）and 1.43（1.14-1.80）for composite outcomes in very low risk+low risk group and high risk+very high risk group,respectively,for incidence of 10-year ICVD in the Q2 group.The[HR（95%CI）]was 1.44（1.05-1.99）for all-cause death in moderate risk group for incidence of 10-year ICVD in the Qd group.（3）There was no significant difference in the risk of all-cause death among the difference SBP groups.Conclusion The risk of cardiovascular adverse events and all-cause mortality were increased in elderly patients with hypertension when SBP≥160mmhg and when 140≤SBP<160mm Hg with a moderate or higher risk of 10-year ICVD.The risk of adverse events was the lowest when 140≤SBP<150 mm Hg with low and lower risk of 10-year ICVD.When 130≤SBP<140 mm Hg and 10-year ICVD was moderate risk or higher,the risk of all-cause death was significantly higher than that of SBP<130mm Hg.There was no correlation between SBP and the risk of all-cause death in the very elderly hypertensive population.Ⅱ Association of Low-Density Lipoprotein Cholesterol with Intracerebral Hemorrhage in the Elderly Patients with HypertensionObjective The aim of this study was to investigate the association of Low-Density Lipoprotein Cholesterol（LDL-C）and intracerebral hemorrhage（ICH）in the elderly patients with hypertension.Methods In this cohort study,based on the Kailuan Study population,9634 elderly hypertensive patients were followed up with the incidence of ICH.Cox proportional hazards model was used to analyze HRs with the corresponding 95%CI of outcome in different LDL-C groups.Results Compared with group LDL-C≤1.74mmol/L,the multivariate Cox proportional hazard regression model showed the hazard ratio[HR（95%CI）]was0.57（0.33-0.99）for ICH in 2.33<LDL-C≤2.92mmol/L,and the[HR（95%CI）]was0.38（0.15-0.99）,when SBP<150mm Hg.And no correlation was shown between them when SBP≥150 mm Hg.Conclusion Low LDL-C levels were associated with increased risk of ICH in elderly hypertensive patients,especially when SBP<150 mm Hg.ⅠⅡ Ⅲ The Effects of Meteorological Factors on All-Cause Mortality in Elderly Patients with HypertensionObjective To investigate the influence of meteorological factors on all-cause mortality in elderly hypertensive patients with different cardiovascular and cerebrovascular risk factors.Methods In this study,based on the Kailuan Study population,9634 elderly hypertensive patients were followed up with the incidence of all cause death.According to gender,age,systolic blood pressure,LDL-C value and 10-year ICVD grade of the observation subjects,the effects of meteorological factors on all-cause mortality of different groups were analyzed by Poisson regression model.Results 1.Decrease of monthly temperature was associated with an increased risk of death in elderly patients with hypertension.Monthly mean air temperature（β=0.974,95%CI:0.962,0.986,P<0.001）,monthly minimum air temperature（β=0.966,95%CI:0.956-0.977,P<0.001）and the highest values（β=0.986,95%CI:0.976-0.996,P=0.005）were associated with a higher risk of total all-cause death.An increase in monthly temperature change was associated with an increased risk of all-cause death in the elderly with hypertension（β=1.098,95%CI:1.051-1.148,P<0.001）.2.Stratified analysis based on age,sex,risk of ischemic vascular disease,baseline systolic blood pressure,low density lipoprotein（LDL）levels,and dust exposure showed that decrease of monthly mean temperature had a more significant impact on the risk of all-cause mortality in male（β=0.973,95%CI:0.961,0.985,p<0.001）,people with a moderate or higher risk of 10-year ICVD.（β=0.971,95%CI:0.958,0.985,p<0.001）and in those with LDL-C<2.6mmol/L（β=0.968,95%CI:0.954,0.983,p<0.001）.3 Decline in monthly minimum temperature and increase in monthly temperature change significantly increased the risk of total death in elderly hypertension population,and had significant influence on the risk of all-cause death in all population except women.The effect of monthly maximum temperature decrease on all-cause mortality risk was more obvious in male population（β=0.985,95%CI:0.975,0.995,p=0.003）,>70 years old population（β=0.984,95%CI:0.971,0.997,p=0.013）,people with a moderate or higher risk of 10-year ICVD,LDL-C<2.6mmol/L population（β=0.983,95%CI:0.970,0.995,p=0.007）,SBP<150mm Hg population（β=0.981,95%CI:0.966,0.998,p=0.024）.In addition to temperature,other meteorological factors also influence the risk of all-cause mortality in elderly patients with hypertension.Increases in monthly mean relative humidity（β=1.018,95%CI:1.012-1.023,p<0.001）and decreases in monthly mean barometric pressure（β=0.978,95%CI:0.962-0.994,p=0.009）were also associated with increased risk of total mortality in elderly hypertensive patients.Barometric pressure having a more significant effect on the risk of death in men,over 70 years of age,with a moderate or higher risk of 10-year ICVD,LDL-C<2.6mmol/L,and with a moderate or higher risk of 10-year ICVD.Conclusion The decrease of monthly air temperature level,the increase of monthly temperature variation,the increase of monthly mean relative humidity and the decrease of barometric pressure were associated with the increased risk of total all-cauth death in the elderly with hypertension,and the effect was more obvious in men,with a moderate or higher risk of 10-year ICVD and LDL-C<2.6mmol/L.