Tatasciore Alfonso, Renda Giulia, Zimarino Marco, Soccio Manola, Bilo Grzegorz, Parati Gianfranco, Schillaci Giuseppe, De Caterina Raffaele
Institute of Cardiology, Center of Excellence on Aging, G. d'Annunzio University, Chieti, Italy.
Hypertension. 2007 Aug;50(2):325-32. doi: 10.1161/HYPERTENSIONAHA.107.090084. Epub 2007 Jun 11.
Growing evidence associates blood pressure (BP) variability with cardiovascular events in hypertensive patients. Here we tested the existence of a relationship between awake BP variability and target-organ damage in subjects referred for suspected hypertension. Systolic and diastolic BP variability were assessed as the standard deviation of the mean out of 24-hour, awake and asleep BP recordings in 180 untreated subjects, referred for suspected hypertension. Measurements were done at 15-minute intervals during daytime and 30-minute intervals during nighttime. Left ventricular mass index (by echo), intima-media thickness (by carotid ultrasonography), and microalbuminuria were assessed as indices of cardiac, vascular and renal damage, respectively. Intima-media thickness and left ventricular mass index progressively increased across tertiles of awake systolic BP variability (P for trend=0.001 and 0.003, respectively). Conversely, microalbuminuria was similar in the 3 tertiles (P=NS). Multivariable analysis identified age (P=0.0001), awake systolic BP (P=0.001), awake systolic BP variability (P=0.015) and diastolic BP load (P=0.01) as independent predictors of intima-media thickness; age (P=0.0001), male sex (P=0.012), awake systolic (P=0.0001) and diastolic BP (P=0.035), and awake systolic BP variability (P=0.028) as independent predictors of left ventricular mass index; awake systolic BP variability (P=0.01) and diastolic BP load (P=0.01) as independent predictors of microalbuminuria. Therefore, awake systolic BP variability by non-invasive ambulatory BP monitoring correlates with sub-clinical target-organ damage, independent of mean BP levels. Such relationship, found in subjects referred for recently suspected hypertension, likely appears early in the natural history of hypertension.
越来越多的证据表明，血压（BP）变异性与高血压患者的心血管事件相关。在此，我们测试了疑似高血压患者清醒时血压变异性与靶器官损害之间关系的存在性。对180名未经治疗的疑似高血压患者进行24小时、清醒和睡眠期间血压记录，以平均血压标准差评估收缩压和舒张压变异性。白天每隔15分钟、夜间每隔30分钟进行测量。分别将左心室质量指数（通过超声心动图）、内膜中层厚度（通过颈动脉超声检查）和微量白蛋白尿作为心脏、血管和肾脏损害的指标。内膜中层厚度和左心室质量指数随着清醒收缩压变异性三分位数的增加而逐渐升高（趋势P分别为0.001和0.003）。相反，微量白蛋白尿在三个三分位数中相似（P=无显著性差异）。多变量分析确定年龄（P=0.0001）、清醒收缩压（P=0.001）、清醒收缩压变异性（P=0.015）和舒张压负荷（P=0.01）是内膜中层厚度的独立预测因素；年龄（P=0.0001）、男性（P=0.012）、清醒收缩压（P=0.0001）和舒张压（P=0.035）以及清醒收缩压变异性（P=0.028）是左心室质量指数的独立预测因素；清醒收缩压变异性（P=0.01）和舒张压负荷（P=0.01）是微量白蛋白尿的独立预测因素。因此，通过无创动态血压监测得到的清醒收缩压变异性与亚临床靶器官损害相关，独立于平均血压水平。在近期疑似高血压患者中发现的这种关系，可能在高血压自然病程的早期就出现了。
