Staessen Jan A, Thijs Lutgarde, O'Brien Eoin T, Bulpitt Christopher J, de Leeuw Peter W, Fagard Robert H, Nachev Choudomir, Palatini Paolo, Parati Gianfranco, Tuomilehto Jaakko, Webster John, Safar Michel E
Study Coordinating Centre, Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, University of Leuven, Belgium.
Am J Hypertens. 2002 Oct;15(10 Pt 1):835-43. doi: 10.1016/s0895-7061(02)02987-4.
We enrolled 808 older patients with isolated systolic hypertension (160 to 219/71 <95 mm Hg) to investigate whether ambulatory measurement of pulse pressure and mean pressure can refine risk stratification. The patients (> or =60 years) were randomized to nitrendipine (10 to 40 mg/day) with the possible addition of enalapril (5 to 20 mg/day) or hydrochlorothiazide (12.5 to 25 mg/day) or to matching placebos. At baseline, pulse pressure and mean pressure were determined from six conventional blood pressure (BP) readings and from 24-h ambulatory recordings. With adjustment for significant covariables, we computed mutually adjusted relative hazard rates associated with 10 mm Hg increases in pulse pressure or mean pressure. In the placebo group, the 24-h and nighttime pulse pressures consistently predicted total and cardiovascular mortality, all cardiovascular events, stroke, and cardiac events. Daytime pulse pressure predicted cardiovascular mortality, all cardiovascular end points, and stroke. The hazard rates for 10 mm Hg increases in pulse pressure ranged from 1.25 to 1.68. Conventionally measured pulse pressure predicted only cardiovascular mortality with a hazard rate of 1.35. In the active treatment group compared with the placebo patients, the relation between outcome and ambulatory pulse pressure was attenuated to a nonsignificant level. Mean pressure determined from ambulatory or conventional BP measurements was not associated with poorer prognosis. In conclusion, in older patients with isolated systolic hypertension higher pulse pressure estimated by 24-h ambulatory monitoring was a better predictor of adverse outcomes than conventional pulse pressure, whereas conventional and ambulatory mean pressures were not correlated with a worse outcome.
我们招募了808例单纯收缩期高血压（收缩压160至219mmHg，舒张压<95mmHg）老年患者，以研究动态测量脉压和平均压是否能优化风险分层。这些患者年龄≥60岁，被随机分为硝苯地平组（10至40mg/天），可加用依那普利（5至20mg/天）或氢氯噻嗪（12.5至25mg/天），或匹配的安慰剂组。基线时，通过6次常规血压读数和24小时动态血压记录来测定脉压和平均压。在对显著协变量进行校正后，我们计算了脉压或平均压每升高10mmHg时相互校正的相对风险率。在安慰剂组中，24小时和夜间脉压始终能预测全因死亡率和心血管死亡率、所有心血管事件、中风和心脏事件。白天脉压能预测心血管死亡率、所有心血管终点事件和中风。脉压每升高10mmHg的风险率在1.25至1.68之间。常规测量的脉压仅能预测心血管死亡率，风险率为1.35。与安慰剂组患者相比，在积极治疗组中，动态脉压与预后之间的关系减弱至无显著意义。通过动态或常规血压测量确定的平均压与预后较差无关。总之，在单纯收缩期高血压老年患者中，24小时动态监测所估计的较高脉压比常规脉压更能预测不良结局，而常规和动态平均压均与较差结局无关。
