Article(id=1324078177395553208, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078175000605624, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202508123, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1754582400000, receivedDateStr=2025-08-08, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614437674, onlineDateStr=2026-11-02, pubDate=1769270400000, pubDateStr=2026-01-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614437674, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614437674, creator=13701087609, updateTime=1793614437674, updator=13701087609, issue=Issue{id=1324078175000605624, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='2', pageStart='193', pageEnd='384', issueExtLink='null', onlineDate='null', pubDate='1769270400000', pubDateStr='2026-01-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614437103, creator='13701087609', updateTime=1793614526046, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078548130082942, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078175000605624, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078548130082943, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078175000605624, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=212, endPage=218, ext={EN=ArticleExt(id=1324078177752069049, articleId=1324078177395553208, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between systolic blood pressure trajectories and stroke risk among older adults aged 65 years and older, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between systolic blood pressure (SBP) trajectories and the risk of stroke among older adults aged ≥65 years.

Methods

Older adults aged ≥65 years from Yangzhong City who participated in at least three rounds of Basic Public Health Service health check-ups between 2016 and 2019 and had no history of cardio-cerebrovascular disease were included.The incidence data of stroke were obtained from the Hospital Information System (HIS) of secondary and above hospitals in Yangzhong City, the Chronic Disease Surveillance Information System of Zhenjiang City, and self-reports from subjects during annual health examinations. Latent class mixed models (LCMM) were used to identify long-term SBP trajectories. Multivariable Cox proportional hazards models were applied to examine the association between different SBP trajectory groups and stroke incidence.

Results

A total of 12 304 older adults were included in the study. LCMM identified two distinct SBP trajectory groups: a low initial SBP with a slight increase group (90.55%) and a high initial SBP with a steep increase group (9.45%). By the end of follow-up on December 31, 2024, totaling 60 266.59 person-years, with an average follow-up time of 4.90 years.2 495 new stroke cases were recorded, with an incidence density of 41.40 per 1 000 person-years. The incidence density was 39.74 per 1 000 person-years in the low initial SBP group and 57.91 per 1 000 person-years in the high initial SBP group. Multivariable Cox proportional hazards analysis showed that compared to the low initial SBP group, the high initial SBP group had a 20% higher risk of stroke (HR=1.20, 95% CI: 1.04-1.38). Stratified analysis showed that the association between SBP trajectory and stroke incidence differed significantly across age groups. In individuals aged over 70 years, the association was stronger (HR=1.26, 95% CI: 1.04-1.51), while in those aged 70 years or younger, the HR was 1.13 (95% CI: 0.91-1.39). The interaction between age and SBP trajectory was statistically significant (P for interaction=0.015).

Conclusion

Among older adults, those with a high initial SBP and a steep increase in SBP over time have a higher risk of stroke. This subgroup should be prioritized in stroke prevention efforts, with strengthened blood pressure monitoring and timely intervention recommended.

, authors=Hai-yuan TONG1, Yuan-yuan FANG2, Zhao-lai HUA3, Yi-long LI1, Xiang FENG3, Jian SU2, 4, authorsList=Hai-yuan TONG, Yuan-yuan FANG, Zhao-lai HUA, Yi-long LI, Xiang FENG, Jian SU, authorCompany=null, correspAuthors=Jian SU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324078179131995068, articleId=1324078177395553208, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=65岁及以上老年人收缩压轨迹与脑卒中发病风险的关联研究—以江苏扬中市为例, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

探讨≥65岁老年人收缩压(systolic blood pressure,SBP)变化轨迹与脑卒中发病风险的关联。

方法

选取扬中市2016—2019年至少参加3次国家基本公共卫生服务健康体检,未患心脑血管疾病的≥65岁老年人为研究对象。脑卒中发病信息来源于扬中市二级及以上医院的HIS系统、镇江市慢性病监测信息系统,以及年度健康体检时研究对象的自我报告。使用潜在类别混合模型(latent class mixed model,LCMM)识别SBP长期变化轨迹,采用多因素Cox比例风险模型分析不同老年人SBP轨迹组与脑卒中发病风险的关联。

结果

共纳入≥65岁老年人12 304名,LCMM共识别出2组SBP轨迹,即低初始SBP微升组(90.55%)和高初始SBP高升组(9.45%)。随访至2024年12月31日,共随访60 266.59人年,平均随访时间4.90年。共新发脑卒中2 495人,总发病密度为41.40/1 000人年;其中低初始SBP微升组为39.74/1 000人年,高初始SBP高升组为57.91/1 000人年。多因素Cox比例风险模型显示,与低初始SBP微升组相比,高初始SBP高升组脑卒中发病风险增加20%(HR=1.20,95% CI:1.04~1.38)。分层分析结果显示,在不同年龄组别间,收缩压轨迹与脑卒中发病风险的关联差异具有统计学意义(>70岁组HR=1.26,95% CI:1.04~1.51;≤70岁组HR=1.13,95% CI:0.91~1.39;交互作用P值=0.015)。

结论

SBP呈高初始水平且快速上升的老年人群发生脑卒中的风险较高,应作为脑卒中防控的重点人群,加强血压监测和干预。

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仝海员(1981—),男,硕士,副主任医师,研究方向:慢性非传染性疾病控制

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苏健,E-mail:
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(In Chinese), articleTitle=Association between Triglyceride Glucose Index and Triglyceride glucose-obesity composite indices and the risk of ischemic heart disease, refAbstract=null)], funds=[Fund(id=1324078190368535544, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, awardId=BJ23027, language=CN, fundingSource=江苏省卫生健康委员会医学科研项目(BJ23027), fundOrder=null, country=null), Fund(id=1324078190439838713, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, awardId=2023-ZJ-169-GG-003, language=CN, fundingSource=镇江市第六期“169工程”科研项目(2023-ZJ-169-GG-003), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324078179798889405, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, xref=1., ext=[AuthorCompanyExt(id=1324078179811472318, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, companyId=1324078179798889405, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Chronic Diseases, Yangzhong City Center for Disease Control and Prevention, Zhenjiang, Jiangsu 212299, China), AuthorCompanyExt(id=1324078179819860927, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, companyId=1324078179798889405, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.扬中市疾病预防控制中心慢病科,江苏 镇江 212299)]), AuthorCompany(id=1324078181212369857, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, xref=2., ext=[AuthorCompanyExt(id=1324078181237535682, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, companyId=1324078181212369857, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.南京医科大学公共卫生学院)]), AuthorCompany(id=1324078181308838851, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, xref=3., ext=[AuthorCompanyExt(id=1324078181346587588, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, companyId=1324078181308838851, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.扬中市人民医院)]), AuthorCompany(id=1324078181501776837, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, xref=4., ext=[AuthorCompanyExt(id=1324078181510165446, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, companyId=1324078181501776837, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.江苏省疾病预防控制中心慢性非传染病防制所)])], figs=[ArticleFig(id=1324078187470271470, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, language=EN, label=Fig.1, caption=SBP trajectory groups in older adults, figureFileSmall=uH6gUBL9uzn2GALC4hfanQ==, figureFileBig=qPNnxWmceiBUjMBRModwkw==, tableContent=null), ArticleFig(id=1324078187575129071, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, language=CN, label=图1, caption=老年人SBP轨迹组, figureFileSmall=uH6gUBL9uzn2GALC4hfanQ==, figureFileBig=qPNnxWmceiBUjMBRModwkw==, tableContent=null), ArticleFig(id=1324078187889701872, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, language=EN, label=Table 1, caption=

Relevant parameters of the fitted LCMM model

, figureFileSmall=null, figureFileBig=null, tableContent=
组数多项式BICAICLog-likelihood各组人数占比(%)Ave PP
1一次(线性)396 187.17396 142.53-198 065.26100NA
二次396 183.91396 131.83-198 058.91100NA
三次396 193.33396 133.82-198 058.91100NA
2一次(线性)396 214.54396 147.58-198 064.7948.90/51.100.50/0.50
二次395 872.48395 790.65-197 884.3290.55/9.450.93/0.75
三次395 891.33395 794.61-197 884.3190.56/9.440.93/0.75
3一次(线性)396 243.33396 154.05-198 065.0328.68/40.27/31.050.33/0.33/0.33
二次395 899.24395 787.64-197 878.829.36/84.82/5.810.68/0.72/0.48
三次395 936.43395 802.52-197 883.2662.51/12.43/25.070.57/0.67/0.46
4一次(线性)396 272.09396 160.49-198 065.250.02/53.22/44.75/2.020.25/0.26/0.26/0.26
二次未拟合成功NANANANA
三次未拟合成功NANANANA
), ArticleFig(id=1324078188103611377, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, language=CN, label=表1, caption=

拟合LCMM模型的相关参数

, figureFileSmall=null, figureFileBig=null, tableContent=
组数多项式BICAICLog-likelihood各组人数占比(%)Ave PP
1一次(线性)396 187.17396 142.53-198 065.26100NA
二次396 183.91396 131.83-198 058.91100NA
三次396 193.33396 133.82-198 058.91100NA
2一次(线性)396 214.54396 147.58-198 064.7948.90/51.100.50/0.50
二次395 872.48395 790.65-197 884.3290.55/9.450.93/0.75
三次395 891.33395 794.61-197 884.3190.56/9.440.93/0.75
3一次(线性)396 243.33396 154.05-198 065.0328.68/40.27/31.050.33/0.33/0.33
二次395 899.24395 787.64-197 878.829.36/84.82/5.810.68/0.72/0.48
三次395 936.43395 802.52-197 883.2662.51/12.43/25.070.57/0.67/0.46
4一次(线性)396 272.09396 160.49-198 065.250.02/53.22/44.75/2.020.25/0.26/0.26/0.26
二次未拟合成功NANANANA
三次未拟合成功NANANANA
), ArticleFig(id=1324078188191691762, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, language=EN, label=Table 2, caption=

Baseline characteristics of participants by SBP trajectory groups

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总人数[n(%)]
(n=12 304)
高初始SBP高升组
[n(%)](n=1 162)
低初始SBP微升组
[n(%)](n=11 142)
t/χ2值P值
性别48.41<0.001
女6 693(54.40)745(64.11)5 948(53.38)
男5 611(45.60)417(35.89)5 194(46.62)
年龄(岁)71.55±5.0772.07±5.3071.50±5.0511.81<0.001
婚姻状况6.840.033
未婚73(0.01)12(1.03)61(0.55)
已婚8 750(71.11)799(68.76)7 951(71.36)
离婚/丧偶/不详3 481(28.29)351(30.21)3 130(28.09)
学历5.630.060
小学及以下6 963(56.59)688(59.21)6 275(56.32)
初高中/中专/大学1 739(14.13)140(12.05)1 599(14.35)
不详3 602(29.28)334(28.74)3 268(29.33)
饮酒状况5.880.120
从不饮酒10 017(81.41)950(81.76)9 067(81.38)
偶尔饮酒470(3.82)30(2.58)440(3.95)
经常饮酒225(1.83)22(1.89)203(1.82)
每天饮酒1 592(12.94)160(13.77)1 432(12.85)
吸烟状况35.10<0.001
从不吸烟9 438(76.71)972(83.65)8 466(75.98)
已戒烟118(0.96)10(0.86)108(0.97)
现在吸烟2 748(22.33)180(15.49)2 568(23.05)
锻炼频率16.35<0.001
不锻炼9 951(80.88)892(76.76)9 059(81.30)
偶尔466(3.79)46(3.96)420(3.77)
经常315(2.56)41(3.53)274(2.46)
每天1 572(12.78)183(15.75)1 389(12.47)
基线BMI(kg/m2)23.68±3.2324.57±3.3223.59±3.2097.79<0.001
基线SBP(mmHg)138.86±18.30165.98±17.32136.03±15.931993.54<0.001
), ArticleFig(id=1324078188267189235, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, language=CN, label=表2, caption=

不同SBP轨迹组研究对象的基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总人数[n(%)]
(n=12 304)
高初始SBP高升组
[n(%)](n=1 162)
低初始SBP微升组
[n(%)](n=11 142)
t/χ2值P值
性别48.41<0.001
女6 693(54.40)745(64.11)5 948(53.38)
男5 611(45.60)417(35.89)5 194(46.62)
年龄(岁)71.55±5.0772.07±5.3071.50±5.0511.81<0.001
婚姻状况6.840.033
未婚73(0.01)12(1.03)61(0.55)
已婚8 750(71.11)799(68.76)7 951(71.36)
离婚/丧偶/不详3 481(28.29)351(30.21)3 130(28.09)
学历5.630.060
小学及以下6 963(56.59)688(59.21)6 275(56.32)
初高中/中专/大学1 739(14.13)140(12.05)1 599(14.35)
不详3 602(29.28)334(28.74)3 268(29.33)
饮酒状况5.880.120
从不饮酒10 017(81.41)950(81.76)9 067(81.38)
偶尔饮酒470(3.82)30(2.58)440(3.95)
经常饮酒225(1.83)22(1.89)203(1.82)
每天饮酒1 592(12.94)160(13.77)1 432(12.85)
吸烟状况35.10<0.001
从不吸烟9 438(76.71)972(83.65)8 466(75.98)
已戒烟118(0.96)10(0.86)108(0.97)
现在吸烟2 748(22.33)180(15.49)2 568(23.05)
锻炼频率16.35<0.001
不锻炼9 951(80.88)892(76.76)9 059(81.30)
偶尔466(3.79)46(3.96)420(3.77)
经常315(2.56)41(3.53)274(2.46)
每天1 572(12.78)183(15.75)1 389(12.47)
基线BMI(kg/m2)23.68±3.2324.57±3.3223.59±3.2097.79<0.001
基线SBP(mmHg)138.86±18.30165.98±17.32136.03±15.931993.54<0.001
), ArticleFig(id=1324078188342686708, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, language=EN, label=Table 3, caption=

Multivariable cox regression analysis of the association between SBP trajectory groups and stroke risk

, figureFileSmall=null, figureFileBig=null, tableContent=
组别模型1模型2模型3
HR(95%CI)P值HR(95%CI)P值HR(95%CI)P值
低初始SBP微升组1.00-1.00-1.00-
高初始SBP高升组1.44(1.28~1.62)<0.0011.38(1.22~1.55)<0.0011.20(1.04~1.38)0.011
组别分析1分析2  
HR(95%CI)P值HR(95%CI)P值
低初始SBP微升组1.00-1.00-  
高初始SBP高升组1.20(1.04~1.38)0.0111.23(1.06~1.43)0.007  
), ArticleFig(id=1324078188426572789, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, language=CN, label=表3, caption=

不同SBP轨迹组与脑卒中发病风险关联的多因素Cox回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
组别模型1模型2模型3
HR(95%CI)P值HR(95%CI)P值HR(95%CI)P值
低初始SBP微升组1.00-1.00-1.00-
高初始SBP高升组1.44(1.28~1.62)<0.0011.38(1.22~1.55)<0.0011.20(1.04~1.38)0.011
组别分析1分析2  
HR(95%CI)P值HR(95%CI)P值
低初始SBP微升组1.00-1.00-  
高初始SBP高升组1.20(1.04~1.38)0.0111.23(1.06~1.43)0.007  
), ArticleFig(id=1324078188502070262, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, language=EN, label=Table 4, caption=

Stratified analysis of the association between SBP trajectory groups and stroke risk

, figureFileSmall=null, figureFileBig=null, tableContent=
分层变量HR(95%CI)P值交互P值
性别0.998
女性(n=6 693)1.20(1.00~1.43)0.047
男性(n=5 611)1.21(0.96~1.51)0.104
年龄0.015
>70岁(n=5 951)1.26(1.04~1.51)0.015
≤70岁(n=6 353)1.13(0.91~1.39)0.270
吸烟状态0.382
从不吸烟(n=9 438)1.21(1.04~1.41)0.012
现在吸烟/已戒烟(n=2 866)1.08(0.76~1.55)0.657
饮酒状态0.529
从不饮酒(n=10 017)1.21(1.03~1.41)0.018
饮酒(n=2 287)1.15(0.83~1.58)0.397
锻炼频率0.104
不锻炼(n=9 951)1.26(1.08~1.48)0.003
锻炼(n=2 353)1.02(0.76~1.37)0.885
), ArticleFig(id=1324078190213346295, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078177395553208, language=CN, label=表4, caption=

不同SBP轨迹组与脑卒中发病风险关联的分层分析

, figureFileSmall=null, figureFileBig=null, tableContent=
分层变量HR(95%CI)P值交互P值
性别0.998
女性(n=6 693)1.20(1.00~1.43)0.047
男性(n=5 611)1.21(0.96~1.51)0.104
年龄0.015
>70岁(n=5 951)1.26(1.04~1.51)0.015
≤70岁(n=6 353)1.13(0.91~1.39)0.270
吸烟状态0.382
从不吸烟(n=9 438)1.21(1.04~1.41)0.012
现在吸烟/已戒烟(n=2 866)1.08(0.76~1.55)0.657
饮酒状态0.529
从不饮酒(n=10 017)1.21(1.03~1.41)0.018
饮酒(n=2 287)1.15(0.83~1.58)0.397
锻炼频率0.104
不锻炼(n=9 951)1.26(1.08~1.48)0.003
锻炼(n=2 353)1.02(0.76~1.37)0.885
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65岁及以上老年人收缩压轨迹与脑卒中发病风险的关联研究—以江苏扬中市为例
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仝海员 1 , 方园园 2 , 华召来 3 , 李一隆 1 , 冯祥 3 , 苏健 2, 4
现代预防医学 | 流行病与统计方法 2026,53(2): 212-218
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现代预防医学 |流行病与统计方法 2026 , 53 (2) : 212 -218
65岁及以上老年人收缩压轨迹与脑卒中发病风险的关联研究—以江苏扬中市为例
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仝海员1, 方园园2, 华召来3, 李一隆1, 冯祥3, 苏健2, 4
作者信息
  • 1.扬中市疾病预防控制中心慢病科,江苏 镇江 212299
  • 2.南京医科大学公共卫生学院
  • 3.扬中市人民医院
  • 4.江苏省疾病预防控制中心慢性非传染病防制所
通讯作者:
苏健,E-mail:
作者简介:

仝海员(1981—),男,硕士,副主任医师,研究方向:慢性非传染性疾病控制

Association between systolic blood pressure trajectories and stroke risk among older adults aged 65 years and older
Hai-yuan TONG1, Yuan-yuan FANG2, Zhao-lai HUA3, Yi-long LI1, Xiang FENG3, Jian SU2, 4
Affiliations
  • Department of Chronic Diseases, Yangzhong City Center for Disease Control and Prevention, Zhenjiang, Jiangsu 212299, China
出版时间: 2026-01-25 doi: 10.20043/j.cnki.MPM.202508123
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目的

探讨≥65岁老年人收缩压(systolic blood pressure,SBP)变化轨迹与脑卒中发病风险的关联。

方法

选取扬中市2016—2019年至少参加3次国家基本公共卫生服务健康体检,未患心脑血管疾病的≥65岁老年人为研究对象。脑卒中发病信息来源于扬中市二级及以上医院的HIS系统、镇江市慢性病监测信息系统,以及年度健康体检时研究对象的自我报告。使用潜在类别混合模型(latent class mixed model,LCMM)识别SBP长期变化轨迹,采用多因素Cox比例风险模型分析不同老年人SBP轨迹组与脑卒中发病风险的关联。

结果

共纳入≥65岁老年人12 304名,LCMM共识别出2组SBP轨迹,即低初始SBP微升组(90.55%)和高初始SBP高升组(9.45%)。随访至2024年12月31日,共随访60 266.59人年,平均随访时间4.90年。共新发脑卒中2 495人,总发病密度为41.40/1 000人年;其中低初始SBP微升组为39.74/1 000人年,高初始SBP高升组为57.91/1 000人年。多因素Cox比例风险模型显示,与低初始SBP微升组相比,高初始SBP高升组脑卒中发病风险增加20%(HR=1.20,95% CI:1.04~1.38)。分层分析结果显示,在不同年龄组别间,收缩压轨迹与脑卒中发病风险的关联差异具有统计学意义(>70岁组HR=1.26,95% CI:1.04~1.51;≤70岁组HR=1.13,95% CI:0.91~1.39;交互作用P值=0.015)。

结论

SBP呈高初始水平且快速上升的老年人群发生脑卒中的风险较高,应作为脑卒中防控的重点人群,加强血压监测和干预。

老年人  /  收缩压  /  脑卒中  /  潜在类别混合模型
Objective

To investigate the association between systolic blood pressure (SBP) trajectories and the risk of stroke among older adults aged ≥65 years.

Methods

Older adults aged ≥65 years from Yangzhong City who participated in at least three rounds of Basic Public Health Service health check-ups between 2016 and 2019 and had no history of cardio-cerebrovascular disease were included.The incidence data of stroke were obtained from the Hospital Information System (HIS) of secondary and above hospitals in Yangzhong City, the Chronic Disease Surveillance Information System of Zhenjiang City, and self-reports from subjects during annual health examinations. Latent class mixed models (LCMM) were used to identify long-term SBP trajectories. Multivariable Cox proportional hazards models were applied to examine the association between different SBP trajectory groups and stroke incidence.

Results

A total of 12 304 older adults were included in the study. LCMM identified two distinct SBP trajectory groups: a low initial SBP with a slight increase group (90.55%) and a high initial SBP with a steep increase group (9.45%). By the end of follow-up on December 31, 2024, totaling 60 266.59 person-years, with an average follow-up time of 4.90 years.2 495 new stroke cases were recorded, with an incidence density of 41.40 per 1 000 person-years. The incidence density was 39.74 per 1 000 person-years in the low initial SBP group and 57.91 per 1 000 person-years in the high initial SBP group. Multivariable Cox proportional hazards analysis showed that compared to the low initial SBP group, the high initial SBP group had a 20% higher risk of stroke (HR=1.20, 95% CI: 1.04-1.38). Stratified analysis showed that the association between SBP trajectory and stroke incidence differed significantly across age groups. In individuals aged over 70 years, the association was stronger (HR=1.26, 95% CI: 1.04-1.51), while in those aged 70 years or younger, the HR was 1.13 (95% CI: 0.91-1.39). The interaction between age and SBP trajectory was statistically significant (P for interaction=0.015).

Conclusion

Among older adults, those with a high initial SBP and a steep increase in SBP over time have a higher risk of stroke. This subgroup should be prioritized in stroke prevention efforts, with strengthened blood pressure monitoring and timely intervention recommended.

Older adults  /  Systolic blood pressure  /  Stroke  /  Latent class mixed model
仝海员, 方园园, 华召来, 李一隆, 冯祥, 苏健. 65岁及以上老年人收缩压轨迹与脑卒中发病风险的关联研究—以江苏扬中市为例. 现代预防医学, 2026 , 53 (2) : 212 -218 . DOI: 10.20043/j.cnki.MPM.202508123
Hai-yuan TONG, Yuan-yuan FANG, Zhao-lai HUA, Yi-long LI, Xiang FENG, Jian SU. Association between systolic blood pressure trajectories and stroke risk among older adults aged 65 years and older[J]. Modern Preventive Medicine, 2026 , 53 (2) : 212 -218 . DOI: 10.20043/j.cnki.MPM.202508123
脑卒中(Stroke)作为我国首位致死致残病因,具有高发病率、高复发率、高致残率、高死亡率及高经济负担的特点[1],已给我国居民带来了沉重的疾病负担[2-3]。根据全球疾病负担(Global Burden of Disease,GBD)数据显示,2019年我国脑卒中新发病例约394万,死亡病例约219万[4]。高收缩压(Systolic Blood Pressure,SBP)是脑卒中最主要的可干预危险因素,其对脑卒中相关伤残调整寿命年(Disability Adjusted Life Year,DALY)的归因比例高达55%[2,5]。
随着年龄增长,SBP水平通常呈上升趋势[7-8],我国75岁人群SBP均值为145 mmHg[11-12]。持续高SBP可加速动脉硬化和血管内皮功能障碍,增加老年人脑卒中发病风险[9-10]。然而,现有研究多关注单一时点的SBP水平与脑卒中发病风险的关联[11-12],忽略了个体的SBP水平会受年龄的增长、生活方式的改变、周围环境等因素的影响[13-14],未能全面评估长期SBP水平与脑卒中发病风险的关联。
近年来,识别不同变化趋势的轨迹分析模型,尤其是潜在类别混合模型(Latent Class Mixed Model,LCMM)逐渐受到关注。此类模型利用血压测量纵向数据,构建个体SBP随时间或年龄变化的轨迹,揭示血压变化发展的不同模式[15-16]。然而,在我国老年人群中,此类证据仍相对有限。因此,本研究拟利用江苏省扬中市老年人健康体检数据,构建当地老年人群的SBP纵向轨迹模型,定量分析不同SBP轨迹组与脑卒中发病风险的关联,为精准化预防脑卒中提供依据。
本研究源于扬中市国家基本公共卫生服务项目老年人健康管理资料,此项目属于按照机构职能开展的常规工作范畴,因此无需经伦理审查。本研究选取2016年参加老年人健康体检(65岁≤年龄<90岁),至2019年具有≥3次健康体检记录且SBP值完整的老年人为研究对象(n=19 182),在此基础上排除2019年及以前已确诊心脑血管疾病者或因该类疾病死亡者(n=4 713),以及相邻两次体质指数(Body Mass Index,BMI)、血压或血糖测量值完全相同或极端异常者(n=2 165),最终12 304名研究对象纳入分析。研究对象的SBP测定频次的中位数为4次,四分位间距为(3,4)次。
依据《国家基本公共卫生服务规范(第三版)》,本研究所有对象均接受问卷调查、体格检查等。由经过统一培训的调查员进行面访调查,主要内容包括:人口学信息(性别、年龄、职业、婚姻状况、教育程度等),生活方式(吸烟情况、饮酒情况、锻炼频率等),个人疾病史(心脏病、脑血管疾病等)。由培训合格的测量员按照统一方法规范测量身高、体重和腰围等指标,并计算BMI。
被测者需在安静环境中休息至少5 min,测量前30 min避免剧烈运动、吸烟、饮酒、进食或情绪激动。测量时,要求被测者坐姿端正,双脚平放于地面,身体保持放松,上臂中点与心脏处于同一水平线。使用经检定合格的上臂式电子血压计测量血压。袖带缠绕位置应距肘窝上方2~3 cm,保持袖带贴合且不过紧。每次体检均对右侧上臂间隔1~2 min测量2次,取两次测量的均值作为当次体检血压测量值。所有体检中的血压测定均严格遵循上述流程,结果记录于居民健康档案并上传至国家基本公共卫生服务管理信息系统。
随访以完成最后一次健康体检开始,本研究的随访截止时间为2024年12月31日,终点事件为随访期间新发脑卒中。根据《疾病和有关健康问题的国际统计分类(第十次修订本)》(The International Classification of Diseases 10th Revision,ICD-10),脑卒中编码为I60~I61,I63~I64。通过扬中市二级及以上医院HIS系统、镇江市慢性病监测信息系统,以及年度健康体检时对象自我报告等方式采集结局信息。若研究对象多次发生脑卒中事件,则以首次发生为准。
采用R 4.4.2软件进行统计分析。计量资料以均数±标准差表示,组间比较使用t检验。计数资料以频数(百分比)表示,组间比较使用χ2检验。通过R 4.4.2软件中LCMM包识别研究对象SBP水平随着时间变化的轨迹模型及分组[17]。考虑SBP水平可能呈现非线性增长趋势,模型中将年龄作为自变量,依次纳入一次项、二次项和三次项,分别构建包含1~4个亚组的轨迹模型。最优轨迹模型的选择基于以下标准进行综合评估:(1)贝叶斯信息规则值(Bayesian Information Criterions,BIC)最小;(2)对数似然值(Log-likelihood)最大;(3)各轨迹组人数不低于总人数的5%;(4)各轨迹组平均后验概率(Average Posterior Probability,Ave PP)>0.7[18]。
采用多因素Cox比例风险回归模型分析不同SBP纵向轨迹组与脑卒中发病风险的关联,采用先验选择,依据脑卒中一级预防与高血压管理相关指南及大型人群研究的既有证据,结合生物学合理性与既往SBP轨迹研究,预先确定需调整的协变量。具体纳入年龄、性别、婚姻状况、吸烟、饮酒、教育程度、身体活动、基线BMI;同时参考同类轨迹研究,在模型中纳入基线SBP。模型1调整年龄(连续型)和性别(男性、女性),模型2在模型1的基础上调整婚姻状况(未婚、已婚、离婚/丧偶/不详)、吸烟状况(从不吸、已戒烟、现在吸烟)、饮酒状况(从不饮酒、偶尔饮酒、经常饮酒、每天饮酒)、教育(小学及以下、初高中/中专/大学、不详)、体育锻炼(不锻炼、偶尔锻炼、经常锻炼、每天锻炼),模型3在模型2的基础上调整基线BMI(连续型)和SBP(连续型)[19-24]。分别以年龄(>70岁、≤70岁)、性别(男性、女性)、吸烟状况(从不吸烟、现在吸烟/已戒烟)、饮酒状况(从不饮酒、饮酒)、锻炼频率(不锻炼、锻炼)为分层变量,采用分层分析评估不同亚组中SBP轨迹与脑卒中发病风险的关联。使用似然比检验判断两组SBP轨迹与分层变量间是否存在交互作用。分别通过剔除随访第一年发生脑卒中的对象和增加调整基线腰围进行敏感性分析,检验结果的稳定性。采用双侧检验,检验水准为α=0.05。
根据轨迹模型选择标准,最终选择以年龄二次项为最高项,包含2个轨迹亚组的模型,2个轨迹亚组分别命名为“低初始SBP微升组”(11 142人,占90.55%)和“高初始SBP高升组”(1 162人,占9.45%)。其中,低初始SBP微升组起始SBP水平较低,随年龄缓慢上升,整体变化较为平稳;高初始SBP高升组起始SBP水平相对较高,且随着年龄增长持续快速升高。见表1和图1。
本研究最终纳入12 304人,其中男性5 611人(54.40%),女性6 693人(45.60%),平均年龄71.55±5.07岁。与低初始SBP微升组相比,高初始SBP高升组研究对象年龄更大,女性、离婚/丧偶/不详、小学及以下、从不吸烟及每天锻炼比例更高,且基线BMI和SBP水平更高(P均<0.05)。见表2。
12 304名研究对象共随访60 266.59人年,平均随访时间4.90年。随访期间新发脑卒中2 495人,发病密度为41.40/1 000人年,其中低初始SBP微升组新发脑卒中2 177人,发病密度为39.74/1 000人年,高初始SBP高升组新发脑卒中318人,发病密度为57.91/1 000人年,两组间发病密度差异有统计学意义(P<0.001)。在调整年龄、性别、文化程度、婚姻状况、吸烟状况、饮酒状况、锻炼频率、基线BMI和基线SBP等混杂因素后,Cox比例风险回归模型显示,与低初始SBP微升组相比,高初始SBP高升组脑卒中发病风险增加20%(HR=1.20,95% CI:1.04~1.38)。见表3。
研究对象按照年龄、性别、吸烟状况、饮酒状况、锻炼频率等变量进行分层分析,结果显示不同SBP轨迹组在不同年龄段间存在交互作用(交互作用P值=0.015),在>70岁的人群中,高初始SBP高升组脑卒中发病风险较低初始SBP微升组增加26%(HR=1.26,95% CI:1.04~1.51),但在≤70岁的人群中未见统计学意义。在不同性别、吸烟状况、饮酒状况、锻炼频率的人群中,不同SBP轨迹组脑卒中发病风险基本保持一致,无交互作用(交互作用P值均>0.05)。见表4。
敏感性分析结果显示,在模型3的基础上额外调整基线腰围,高初始SBP高升组脑卒中发病风险较低初始SBP微升组增加20%(HR=1.20,95% CI:1.04~1.38),在排除随访第一年发生脑卒中的对象,高初始SBP高升组脑卒中发病风险较低初始SBP微升组增加23%(HR=1.23,95% CI:1.06~1.43),与主结果分析基本一致。见表3。
本研究依托江苏省扬中市国家基本公共卫生服务项目,使用LCMM模型拟合老年人群SBP水平随时间变化轨迹。与低初始SBP微升组相比,高初始SBP高升组脑卒中发生风险显著升高,且该关联在>70岁人群中更强。
本研究综合考虑统计学指标和医学合理性后,最终在老年人群中识别出2组SBP轨迹组。虽然本研究得到的SBP轨迹组数较少,但老年人群血压轨迹总体趋势与既往研究仍基本保持一致。一项研究使用联合LCMM模型,在荷兰55~106岁人群中识别出正常-缓慢增高-超常组(73.21%)、正常-快速增加-超常组(12.19%)、稳定中等水平组(12.90%)、稳定高水平组(1.70%)四组SBP变化轨迹[16]。我国一项针对50~70岁的健康人群队列研究,使用LCMM模型拟合研究对象血压变化轨迹,分别呈低-缓慢-增高组(86.50%)、低-增高组(8.10%)、中-增高组(5.40%)[23]。另一项基于中国健康与养老追踪调查研究,使用GBTM模型拟合老年人群8年间SBP变化轨迹,结果显示呈正常-稳定高组(46.86%)、正常-低增加组(42.56%)、超常-下降组(10.58%)[20]。各研究的随访时长、多次数据收集的时间间隔[25]、轨迹拟合的方法不同[26-27]、以及研究人群的年龄范围差异,都可能影响最终识别的轨迹组数量。英国的队列研究表明,中年人群SBP先呈上升趋势,到中年后期SBP增速减慢,65岁后SBP开始下降[28],提示各年龄段SBP自然波动水平不同,也可能会影响SBP最终轨迹组。
本研究发现,高初始SBP高升组的脑卒中发生风险显著高于低初始SBP微升组,与既往研究结果一致。Wang等基于广州生物样本库队列中老年人群研究结果显示,SBP轨迹为中-增高组的脑卒中发病风险是低-缓慢-增高组的1.88倍(HR=1.88,95% CI:1.37~2.60)[23]。Li等基于河南省焦作市社区中老年人群队列的研究表明,SBP轨迹为高-急速增加组的脑卒中发病风险是低-稳定组的3.05倍(HR=3.05,95% CI:1.76~5.27)[29]。高初始SBP高升组在基线时即表现出较高的SBP水平,且在随访期间SBP呈持续升高趋势,提示该类人群长期血压控制不良。长期SBP升高可引起血管壁顺应性下降、内皮功能受损,导致大动脉弹性减弱、小动脉玻璃样变性和脑微血管病变,进而增加脑卒中的发生风险[30-31]。此外,持续升高的SBP还反映了个体较差的血流动力学稳定性,这种血压波动可能诱发脑动脉粥样斑块破裂或微血栓形成,从而引发脑卒中[32]。分层分析结果提示,在>70岁的老年人群,高初始SBP高升组脑卒中发生风险更高,可能与老年人的神经-心血管调节功能减退,血压波动性逐渐减弱[33],且长期处于SBP升高状态有关。因此,控制上述高风险人群对脑卒中的精准预防具有重要意义。
本研究基于SBP随时间的动态变化趋势,对扬中市老年人群进行了轨迹识别。与传统静态血压测量相比,轨迹分析能够更全面反映个体的长期血压变化模式,并识别出脑卒中的高发病风险群体。在基层公共卫生工作中,应充分利用连续性体检数据,为老年人构建SBP变化轨迹,对识别为高风险轨迹个体适当缩短随访间隔,加强家庭血压监测及规范用药管理,并同步推进控烟、限酒、体重管理与体力活动等综合干预措施,将血压维持在稳定水平。通过识别高风险群体,进行精准化干预,有助于降低脑卒中的发病风险。本研究中仍存在一定的局限性。本研究终点事件主要源于疾病登记信息系统,并辅以对象自报,但仍可能存在漏报情况,造成信息偏倚;不同的医疗机构采用不同的品牌、型号的电子血压计,可能会造成一定的测量误差,但医疗机构定期校准电子血压计以保证测量准确性;仅纳入研究期间接受至少三次体检的老年人,排除体检次数不足的老年人,可能存在选择偏倚;本研究虽已调整多个混杂因素,但尚不能排除其他混杂因素,如睡眠质量、药物使用等对研究结果的影响;此外,本研究的研究人群仅涵盖扬中市,可能会限制研究结果对其他地区人群的适用性,结论外推时需谨慎,未来仍需大样本、多中心的研究验证结果[34]。
综上所述,与低初始SBP微升轨迹相比,高初始SBP高升轨迹具有较高的老年人脑卒中发病风险,尤其是在>70岁的老年人群中。因此,在日常血压监测管理工作中,应加强关注老年人SBP随着时间的变化轨迹,识别脑卒中高风险群体,进行精准化干预,以降低脑卒中疾病负担。
  • 江苏省卫生健康委员会医学科研项目(BJ23027)
  • 镇江市第六期“169工程”科研项目(2023-ZJ-169-GG-003)
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2026年第53卷第2期
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doi: 10.20043/j.cnki.MPM.202508123
  • 接收时间:2025-08-08
  • 首发时间:2026-11-02
  • 出版时间:2026-01-25
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  • 收稿日期:2025-08-08
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江苏省卫生健康委员会医学科研项目(BJ23027)
镇江市第六期“169工程”科研项目(2023-ZJ-169-GG-003)
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    1.扬中市疾病预防控制中心慢病科,江苏 镇江 212299
    2.南京医科大学公共卫生学院
    3.扬中市人民医院
    4.江苏省疾病预防控制中心慢性非传染病防制所

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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