Boggia José, Li Yan, Thijs Lutgarde, Hansen Tine W, Kikuya Masahiro, Björklund-Bodegård Kristina, Richart Tom, Ohkubo Takayoshi, Kuznetsova Tatiana, Torp-Pedersen Christian, Lind Lars, Ibsen Hans, Imai Yutaka, Wang Jiguang, Sandoya Edgardo, O'Brien Eoin, Staessen Jan A
Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
Lancet. 2007 Oct 6;370(9594):1219-29. doi: 10.1016/S0140-6736(07)61538-4.
Few studies have formally compared the predictive value of the blood pressure at night over and beyond the daytime value. We investigated the prognostic significance of the ambulatory blood pressure during night and day and of the night-to-day blood pressure ratio.
We did 24-h blood pressure monitoring in 7458 people (mean age 56.8 years [SD 13.9]) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uruguay, and China. We calculated multivariate-adjusted hazard ratios for daytime and night-time blood pressure and the systolic night-to-day ratio, while adjusting for cohort and cardiovascular risk factors.
Median follow-up was 9.6 years (5th to 95th percentile 2.5-13.7). Adjusted for daytime blood pressure, night-time blood pressure predicted total (n=983; p<0.0001), cardiovascular (n=387; p<0.01), and non-cardiovascular (n=560; p<0.001) mortality. Conversely, adjusted for night-time blood pressure, daytime blood pressure predicted only non-cardiovascular mortality (p<0.05), with lower blood pressure levels being associated with increased risk. Both daytime and night-time blood pressure consistently predicted all cardiovascular events (n=943; p<0.05) and stroke (n=420; p<0.01). Adjusted for night-time blood pressure, daytime blood pressure lost prognostic significance only for cardiac events (n=525; p> or =0.07). Adjusted for the 24-h blood pressure, night-to-day ratio predicted mortality, but not fatal combined with non-fatal events. Antihypertensive drug treatment removed the significant association between cardiovascular events and the daytime blood pressure. Participants with systolic night-to-day ratio value of 1 or more were older, at higher risk of death, and died at an older age than those whose night-to-day ratio was normal (> or =0.80 to <0.90).
In contrast to commonly held views, daytime blood pressure adjusted for night-time blood pressure predicts fatal combined with non-fatal cardiovascular events, except in treated patients, in whom antihypertensive drugs might reduce blood pressure during the day, but not at night. The increased mortality in patients with higher night-time than daytime blood pressure probably indicates reverse causality. Our findings support recording the ambulatory blood pressure during the whole day.
很少有研究正式比较夜间血压相对于日间血压的预测价值。我们调查了昼夜动态血压及夜间与日间血压比值的预后意义。
我们对丹麦、比利时、日本、瑞典、乌拉圭和中国前瞻性人群研究中纳入的7458人(平均年龄56.8岁[标准差13.9])进行了24小时血压监测。我们计算了日间和夜间血压以及收缩压夜间与日间比值的多变量调整风险比,同时对队列和心血管危险因素进行了调整。
中位随访时间为9.6年(第5至第95百分位数为2.5 - 13.7年)。在调整了日间血压后,夜间血压可预测全因死亡(n = 983;p < 0.0001)、心血管死亡(n = 387;p < 0.01)和非心血管死亡(n = 560;p < 0.001)。相反,在调整了夜间血压后,日间血压仅能预测非心血管死亡(p < 0.05),血压水平越低风险越高。日间和夜间血压均能持续预测所有心血管事件(n = 943;p < 0.05)和中风(n = 420;p < 0.0