Ingelsson Erik, Björklund-Bodegård Kristina, Lind Lars, Arnlöv Johan, Sundström Johan
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
JAMA. 2006 Jun 28;295(24):2859-66. doi: 10.1001/jama.295.24.2859.
High blood pressure is the most important risk factor for congestive heart failure (CHF) at a population level, but the relationship of an altered diurnal blood pressure pattern to risk of subsequent CHF is unknown.
To explore 24-hour ambulatory blood pressure characteristics as predictors of CHF incidence and to investigate whether altered diurnal blood pressure patterns confer any additional risk information beyond that provided by conventional office blood pressure measurements.
DESIGN, SETTING, AND PARTICIPANTS: Prospective, community-based, observational cohort in Uppsala, Sweden, including 951 elderly men free of CHF, valvular disease, and left ventricular hypertrophy at baseline between 1990 and 1995, followed up until the end of 2002. Twenty-four-hour ambulatory blood pressure monitoring was performed at baseline, and the blood pressure variables were analyzed as predictors of subsequent CHF.
First hospitalization for CHF.
Seventy men developed heart failure during follow-up, with an incidence rate of 8.6 per 1000 person-years at risk. In multivariable Cox proportional hazards models adjusted for antihypertensive treatment and established risk factors for CHF (myocardial infarction, diabetes, smoking, body mass index, and serum cholesterol level), a 1-SD (9-mm Hg) increase in nighttime ambulatory diastolic blood pressure (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.02-1.55) and the presence of "nondipping" blood pressure (night-day ambulatory blood pressure ratio > or =1; HR, 2.29; 95% CI, 1.16-4.52) were associated with an increased risk of CHF. After adjusting for office-measured systolic and diastolic blood pressures, nondipping blood pressure remained a significant predictor of CHF (HR, 2.21; 95% CI, 1.12-4.36 vs normal night-day pattern). Nighttime ambulatory diastolic blood pressure and nondipping blood pressure were also significant predictors of CHF after exclusion of all participants who had an acute myocardial infarction before baseline or during follow-up.
Nighttime blood pressure appears to convey additional risk information about CHF beyond office-measured blood pressure and other established risk factors for CHF. The clinical value of this association remains to be established in future studies.
在人群层面，高血压是充血性心力衰竭（CHF）最重要的危险因素，但日间血压模式改变与后续CHF风险之间的关系尚不清楚。
探讨24小时动态血压特征作为CHF发病率的预测指标，并研究日间血压模式改变是否能提供超出传统诊室血压测量的额外风险信息。
设计、地点和参与者：瑞典乌普萨拉一项基于社区的前瞻性观察队列研究，纳入951名基线时无CHF、瓣膜病和左心室肥厚的老年男性，研究时间为1990年至1995年，随访至2002年底。在基线时进行24小时动态血压监测，并将血压变量作为后续CHF的预测指标进行分析。
首次因CHF住院。
70名男性在随访期间发生心力衰竭，风险发生率为每1000人年8.6例。在多变量Cox比例风险模型中，校正了抗高血压治疗和已确定的CHF风险因素（心肌梗死、糖尿病、吸烟、体重指数和血清胆固醇水平）后，夜间动态舒张压升高1个标准差（9 mmHg）（风险比[HR]，1.26；95%置信区间[CI]，1.02 - 1.55）以及存在“非勺型”血压（夜间 - 日间动态血压比值≥1；HR，2.29；95% CI，1.16 - 4.52）与CHF风险增加相关。在校正诊室测量的收缩压和舒张压后，非勺型血压仍然是CHF的显著预测指标（HR，2.21；95% CI，1.12 - 4.36，与正常夜间 - 日间模式相比）。在排除所有基线前或随访期间发生急性心肌梗死的参与者后，夜间动态舒张压和非勺型血压也是CHF的显著预测指标。
夜间血压似乎能提供超出诊室测量血压和其他已确定的CHF风险因素的关于CHF的额外风险信息。这种关联的临床价值仍有待未来研究确定。
