Mena Luis, Pintos Salvador, Queipo Nestor V, Aizpúrua José A, Maestre Gladys, Sulbarán Tulio
Department of Computer Science, University of Zulia, Maracaibo, Venezuela.
J Hypertens. 2005 Mar;23(3):505-11. doi: 10.1097/01.hjh.0000160205.81652.5a.
This study presents a reliable index inspired by the total variability concept of real analysis in mathematics, called average real variability (ARV), for the prognostic significance of blood pressure variability (BPV) overcoming the pitfalls of the commonly used standard deviation (SD).
Recent studies have suggested that an increase in BPV is associated with an increase in subsequent cardiovascular events/complications. However, there are other studies where the cited association was not found or was lost in the presence of other well-known risk factors. An explanation for these apparently contradictory results may be the selection of the variability index used (SD).
Ambulatory blood pressure monitoring in 312 subjects aged > or = 55 years. Logistic regression models and survival methods were used to establish the prognostic significance of awake systolic BPV: in particular, (i) the performance of ARV versus SD, and (ii) the value of BPV relative to other well-known risk factors.
The analyses using the ARV index show a statistically significant relative risk equal to 4.548 (P = 0.006) for the group with high BPV with respect to the low BPV group (reference level); in contrast, the corresponding relative risk associated to the SD index was not statistically significant. Furthermore, ARV exhibited a similar predictive value to systolic blood pressure.
The proposed ARV index is a more reliable representation of time series variability than SD and may be less sensitive to the relative low sampling frequency of the ambulatory blood pressure monitoring devices. The results suggest that ARV adds prognostic value to the ABPM and could prompt the use of therapeutic measures to control BPV.
本研究提出了一种受数学实分析中总变异性概念启发的可靠指标，称为平均实际变异性（ARV），用于评估血压变异性（BPV）的预后意义，克服了常用标准差（SD）的缺陷。
近期研究表明，BPV增加与随后心血管事件/并发症增加相关。然而，在其他研究中，这种关联未被发现，或在存在其他知名危险因素时消失。这些明显矛盾结果的一个解释可能是所使用的变异性指标（SD）的选择。
对312名年龄≥55岁的受试者进行动态血压监测。使用逻辑回归模型和生存方法来确定清醒收缩压BPV的预后意义：特别是，（i）ARV与SD的性能比较，以及（ii）BPV相对于其他知名危险因素的值。
使用ARV指标的分析显示，高BPV组相对于低BPV组（参考水平）的统计学显著相对风险等于4.548（P = 0.006）；相比之下，与SD指标相关的相应相对风险无统计学意义。此外，ARV表现出与收缩压相似的预测价值。
所提出的ARV指标比SD更能可靠地表示时间序列变异性，并且可能对动态血压监测设备相对较低的采样频率不太敏感。结果表明，ARV为动态血压监测增加了预后价值，并可能促使采取治疗措施来控制BPV。
