Pierdomenico Sante D, Lapenna Domenico, Cuccurullo Franco
Department of Medicine and Aging Science, University Gabriele d'Annunzio, and Clinical Research Center, University Gabriele d'Annunzio Foundation, Chieti, Italy.
Blood Press Monit. 2008 Aug;13(4):193-7. doi: 10.1097/MBP.0b013e3282feea70.
The risk of atrial fibrillation (AF) in sustained hypertensive patients with different circadian blood pressure (BP) patterns is unknown. We investigated the risk of new onset AF in dipper and nondipper sustained hypertensive patients.
The occurrence of AF was evaluated in 1141 patients aged > or = 40 years with sustained hypertension (clinic BP > or = 140 and/or 90 mmHg and daytime BP > or = 135 and/or 85 mmHg). Among these patients, 783 had night-time systolic BP fall > or = 10% (dippers) and 358 had night-time BP decline <10% (nondippers).
During the follow-up (6.1+/-3.2, range 0.5-12.9 years), AF occurred in 43 patients. The AF rate per 100 patient-years in dippers and nondippers was 0.38 and 1.13, respectively. AF free survival was significantly different between the groups (P=0.0002). After adjustment for other covariates, including left atrial enlargement or left ventricular hypertrophy (these variables were analyzed in separate models because of a strong association between them) and 24-h BP, Cox regression analysis showed that the risk of AF was significantly higher in nondippers than in dippers [nondippers vs. dippers, relative risk (RR) 2.02, 95% confidence interval (CI) 1.08-3.79, P=0.028 in the model including left atrial enlargement, and RR 1.97, 95% CI: 1.05-3.69, P=0.035 in the model including left ventricular hypertrophy].
This study shows that nondipper sustained hypertensive patients have a two-fold greater risk of developing AF than dipper ones. This aspect could partly contribute to explain the higher cardiovascular risk previously observed in nondipper hypertensive patients.
不同昼夜血压模式的持续性高血压患者发生心房颤动（AF）的风险尚不清楚。我们调查了杓型和非杓型持续性高血压患者新发AF的风险。
对1141例年龄≥40岁的持续性高血压患者（诊室血压≥140和/或90 mmHg，日间血压≥135和/或85 mmHg）的AF发生情况进行评估。其中，783例夜间收缩压下降≥10%（杓型），358例夜间血压下降<10%（非杓型）。
在随访期间（6.1±3.2年，范围0.5 - 12.9年），43例患者发生AF。杓型和非杓型患者每100患者年的AF发生率分别为0.38和1.13。两组间无AF生存情况有显著差异（P = 0.0002）。在调整其他协变量后，包括左心房扩大或左心室肥厚（由于它们之间存在强关联，这些变量在单独模型中分析）和24小时血压，Cox回归分析显示非杓型患者发生AF的风险显著高于杓型患者[非杓型与杓型相比，相对风险（RR）2.02，95%置信区间（CI）1.08 - 3.79，在包括左心房扩大的模型中P = 0.028；RR 1.97，95% CI：1.05 - 3.69，在包括左心室肥厚的模型中P = 0.035]。
本研究表明，非杓型持续性高血压患者发生AF的风险是杓型患者的两倍。这一方面可能部分有助于解释先前在非杓型高血压患者中观察到的较高心血管风险。
