Fagard Robert H, Celis Hilde, Thijs Lutgarde, Staessen Jan A, Clement Denis L, De Buyzere Marc L, De Bacquer Dirk A
Hypertension and Cardiovascular Rehabilitation Unit, Faculty of Medicine, University of Leuven, Belgium.
Hypertension. 2008 Jan;51(1):55-61. doi: 10.1161/HYPERTENSIONAHA.107.100727. Epub 2007 Nov 26.
Our aim was to assess the prognostic significance of nighttime and daytime ambulatory blood pressure and their ratio for mortality and cause-specific cardiovascular events in hypertensive patients without major cardiovascular disease at baseline. We performed a meta-analysis on individual data of 3468 patients from 4 prospective studies performed in Europe. Age of the subjects averaged 61+/-13 years, 45% were men, 13.7% smoked, 8.4% had diabetes, and 61% were under antihypertensive treatment at the time of ambulatory blood pressure monitoring. Office, daytime, and nighttime blood pressure averaged 159+/-20/91+/-12, 143+/-17/87+/-12, and 130+/-18/75+/-12 mm Hg. Total follow-up amounted to 23 164 patient-years. We used multivariable Cox regression analysis to assess the hazard ratios associated with 1 standard deviation higher blood pressure. Daytime and nighttime systolic blood pressure predicted all-cause and cardiovascular mortality, coronary heart disease, and stroke, independently from office blood pressure and confounding variables. When these blood pressures were entered simultaneously into the models, nighttime blood pressure predicted all outcomes, whereas daytime blood pressure did not add prognostic precision to nighttime pressure. Appropriate interaction terms indicated that the results were similar in men and women, in younger and older patients, and in treated and untreated patients The systolic night-day blood pressure ratio predicted all outcomes, which only persisted for all-cause mortality after adjustment for 24-hour blood pressure. In conclusion, nighttime blood pressure is in general a better predictor of outcome than daytime pressure in hypertensive patients, and the night-day blood pressure ratio predicts mortality, even after adjustment for 24-hour blood pressure.
我们的目的是评估夜间和日间动态血压及其比值对基线时无重大心血管疾病的高血压患者死亡率和特定病因心血管事件的预后意义。我们对欧洲进行的4项前瞻性研究中3468例患者的个体数据进行了荟萃分析。受试者年龄平均为61±13岁，45%为男性，13.7%吸烟，8.4%患有糖尿病，61%在进行动态血压监测时接受抗高血压治疗。诊室、日间和夜间血压平均分别为159±20/91±12、143±17/87±12和130±18/75±12 mmHg。总随访时间达23164患者年。我们使用多变量Cox回归分析来评估与血压升高1个标准差相关的风险比。日间和夜间收缩压可独立于诊室血压和混杂变量预测全因死亡率、心血管死亡率、冠心病和中风。当将这些血压同时纳入模型时，夜间血压可预测所有结局，而日间血压并未增加对夜间血压预后的预测精度。适当的交互项表明，在男性和女性、年轻和老年患者以及接受治疗和未接受治疗的患者中结果相似。收缩压昼夜比值可预测所有结局，在调整24小时血压后，仅全因死亡率仍存在这种关联。总之，在高血压患者中，一般而言夜间血压比日间血压是更好的结局预测指标，并且昼夜血压比值可预测死亡率，即使在调整24小时血压后亦是如此。
