Mancia Giuseppe, Bombelli Michele, Facchetti Rita, Madotto Fabiana, Corrao Giovanni, Trevano Fosca Quarti, Grassi Guido, Sega Roberto
Clinica Medica and Dipartimento di Medicina Clinica e Prevenzione, Università Milano-Bicocca, Ospedale San Gerardo, Monza, Milan, Italy.
Hypertension. 2007 Jun;49(6):1265-70. doi: 10.1161/HYPERTENSIONAHA.107.088708. Epub 2007 Apr 23.
The hypothesis has been advanced that cardiovascular prognosis is related not only to 24-hour mean blood pressure but also to blood pressure variability. Data, however, are inconsistent, and no long-term prognostic study is available. In 2012 individuals randomly selected from the population of Monza (Milan), 24-hour ambulatory blood pressure (Spacelabs 90207) was measured via readings spaced by 20 minutes. Systolic and diastolic blood pressure variability was obtained by calculating the following: (1) the SD of 24-hour, day, and night mean values; (2) the day-night blood pressure difference; and (3) the residual or erratic blood pressure variability (Fourier spectral analysis). Fatal cardiovascular and noncardiovascular events were registered for 148 months. When adjusted for age, sex, 24-hour mean blood pressure, and other risk factors, there was no relationship between the risk of death and 24-hour, day, and night blood pressure SDs. In contrast, the adjusted risk of cardiovascular death was inversely related to day-night diastolic BP difference (beta coefficient=-0.040; P<0.02) and showed a significant positive relationship with residual diastolic blood pressure variability (beta coefficient=0.175; P<0.002). Twenty-four-hour mean blood pressure attenuation of nocturnal hypotension and erratic diastolic blood pressure variability all independently predicted the mortality risk, with the erratic variability being the most important factor. Our data show that the relationship of blood pressure to prognosis is complex and that phenomena other than 24-hour mean values are involved. They also provide the first evidence that short-term erratic components of blood pressure variability play a prognostic role, with their increase being accompanied by an increased cardiovascular risk.
有一种假说认为，心血管预后不仅与24小时平均血压有关，还与血压变异性有关。然而，数据并不一致，且尚无长期预后研究。2012年，从蒙扎（米兰）人群中随机选取个体，通过每20分钟一次的读数测量24小时动态血压（太空实验室90207）。收缩压和舒张压变异性通过计算以下指标得出：（1）24小时、白天和夜间平均值的标准差；（2）昼夜血压差值；（3）残余或不稳定血压变异性（傅里叶频谱分析）。记录148个月内的致命心血管和非心血管事件。在对年龄、性别、24小时平均血压和其他危险因素进行校正后，死亡风险与24小时、白天和夜间血压标准差之间无关联。相比之下，校正后的心血管死亡风险与昼夜舒张压差值呈负相关（β系数=-0.040；P<0.02），与残余舒张压变异性呈显著正相关（β系数=0.175；P<0.002）。24小时平均血压、夜间低血压的减弱以及不稳定舒张压变异性均独立预测死亡风险，其中不稳定变异性是最重要的因素。我们的数据表明，血压与预后的关系很复杂，涉及24小时平均值以外的其他现象。它们还首次证明，血压变异性的短期不稳定成分具有预后作用，其增加伴随着心血管风险的增加。
