Eto Masato, Toba Kenji, Akishita Masahiro, Kozaki Koichi, Watanabe Tokumitsu, Kim Seungbum, Hashimoto Masayoshi, Ako Junya, Iijima Katsuya, Sudoh Noriko, Yoshizumi Masao, Ouchi Yasuyoshi
Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Hypertens Res. 2005 Jan;28(1):1-7. doi: 10.1291/hypres.28.1.
Blood pressure variability is one of the characteristic features of hypertension in the elderly. However, its clinical significance remains to be determined. We therefore examined the impact of blood pressure variability on the development of cardiovascular events in elderly hypertensive patients. A total of 106 consecutive hypertensive patients aged more than 60 years old (mean age, 73.9 +/- 8.1 years old; male, 54%), all of whom underwent 24-h ambulatory blood pressure monitoring, were followed up (median, 34 months; range, 3-60 months). During the follow-up period, 39 cardiovascular events were observed, including 14 cases of cerebral infarction and 7 cases of acute myocardial infarction. The coefficient of variation (CV) of 24-h systolic blood pressure (SBP) values was used as an index of blood pressure variability. The patients showed a mean CV value of 10.6%, and were divided into two groups according to this mean value as a cut-off point: a high CV group (n = 46) and a low CV group (n = 60). Although baseline clinical characteristics were similar in the two groups, Kaplan-Meier plots for event-free survival revealed that the rate of cardiovascular events was significantly higher in high CV group than in low CV group (p < 0.05). Cox's proportional hazards analysis showed that increased blood pressure variability (a high CV value of 24-h SBP) was an independent predictive variable for cardiovascular events. The CV value of daytime SBP and the SD value of both 24-h SBP and daytime SBP also had positive correlations with the onset of cardiovascular events. These results suggest that increased blood pressure variability may be an independent risk factor for cardiovascular events in elderly hypertensive patients.
血压变异性是老年高血压的特征之一。然而，其临床意义仍有待确定。因此，我们研究了血压变异性对老年高血压患者心血管事件发生的影响。共有106例连续的60岁以上高血压患者（平均年龄73.9±8.1岁；男性54%），所有患者均接受了24小时动态血压监测，并进行随访（中位数34个月；范围3 - 60个月）。在随访期间，观察到39例心血管事件，包括14例脑梗死和7例急性心肌梗死。24小时收缩压（SBP）值的变异系数（CV）用作血压变异性指标。患者的平均CV值为10.6%，并根据该平均值作为分界点分为两组：高CV组（n = 46）和低CV组（n = 60）。虽然两组的基线临床特征相似，但无事件生存的Kaplan - Meier曲线显示，高CV组的心血管事件发生率显著高于低CV组（p < 0.05）。Cox比例风险分析表明，血压变异性增加（24小时SBP的高CV值）是心血管事件的独立预测变量。日间SBP的CV值以及24小时SBP和日间SBP的标准差（SD）值也与心血管事件的发生呈正相关。这些结果表明，血压变异性增加可能是老年高血压患者心血管事件的独立危险因素。
