Khattar R S, Swales J D, Banfield A, Dore C, Senior R, Lahiri A
Department of Cardiovascular Medicine, Northwick Park and St Mark's Hospital NHS Trust and Institute for Medical Research, Harrow, Middlesex, UK.
Circulation. 1999 Sep 7;100(10):1071-6. doi: 10.1161/01.cir.100.10.1071.
The goal of this study was to assess the prognostic value of ambulatory versus clinic blood pressure measurement and to relate cardiovascular risk to ambulatory systolic and diastolic blood pressure levels.
The study population consisted of 688 patients 51+/-11 years of age who had undergone pretreatment 24-hour intra-arterial ambulatory blood pressure monitoring on the basis of elevated clinic blood pressure. A total of 157 first events were recorded during a 9.2+/-4.1-year follow-up period. The predictive value of a regression model containing age, sex, race, body mass index, smoking, diabetes mellitus, fasting cholesterol level, and previous history of cardiovascular disease was significantly improved by the addition of any ambulatory systolic or diastolic blood pressure parameter (whether 24-hour, daytime, or nighttime mean) or pulse pressure, whereas inclusion of baseline clinic blood pressure variables did not enhance the prediction of events. The most predictive models contained the ambulatory systolic blood pressure parameters. In the model containing 24-hour mean ambulatory systolic blood pressure (P=0.001), age (P<0.001), male sex (P<0.001), South Asian origin (P=0.008), diabetes mellitus (P=0. 05), and previous cardiovascular disease (P<0.001) were additional independent predictors of events. Whereas 24-hour ambulatory systolic blood pressure was linearly related to the incidence of both coronary and cerebrovascular events, 24-hour ambulatory diastolic blood pressure exhibited a positive linear relationship with cerebrovascular events but a curvilinear relationship with coronary events.
Ambulatory blood pressure is superior to clinic measurement for the assessment of cardiovascular risk; there is no reduction in coronary risk at lower levels of ambulatory diastolic blood pressure.
本研究的目的是评估动态血压测量与诊室血压测量的预后价值，并将心血管风险与动态收缩压和舒张压水平相关联。
研究人群包括688例年龄在51±11岁的患者，这些患者因诊室血压升高而在治疗前接受了24小时动脉内动态血压监测。在9.2±4.1年的随访期内共记录到157例首次事件。包含年龄、性别、种族、体重指数、吸烟、糖尿病、空腹胆固醇水平和心血管疾病既往史的回归模型，通过添加任何动态收缩压或舒张压参数（无论是24小时、日间或夜间平均值）或脉压，其预测价值均显著提高，而纳入基线诊室血压变量并未增强对事件的预测。预测性最强的模型包含动态收缩压参数。在包含24小时动态收缩压平均值的模型中（P=0.001），年龄（P<0.001）、男性（P<0.001）、南亚裔（P=·008）、糖尿病（P=0.05）和既往心血管疾病（P<0.001）是事件的额外独立预测因素。虽然24小时动态收缩压与冠状动脉事件和脑血管事件的发生率均呈线性相关，但24小时动态舒张压与脑血管事件呈正线性关系，与冠状动脉事件呈曲线关系。
动态血压在评估心血管风险方面优于诊室测量；动态舒张压水平较低时，冠状动脉风险并无降低。
