Fagard Robert H, 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, KU Leuven, Belgium.
Blood Press Monit. 2008 Dec;13(6):325-32. doi: 10.1097/MBP.0b013e32831054f5.
To assess the prognostic significance of nighttime and daytime blood pressure (BP), their ratio and the nighttime dipping pattern for mortality and recurrent cardiovascular (CV) events in patients with CV disease at baseline.
The prognostic value of ambulatory BP has not been reported in hypertensive patients with a history of CV disease.
We performed a meta-analysis on individual data of 302 patients with hypertension and CV disease from three prospective studies performed in Europe.
Age of the patients averaged 69+/-9 years; 50% were men and 62% were under antihypertensive treatment at the time of ambulatory BP monitoring. Office, daytime and nighttime BP averaged 161+/-20/86+/-12, 144+/-16/83+/-11 and 132+/-18/72+/-12 mmHg. Total follow-up time amounted to 2049 patient--years. Multivariable Cox regression analysis revealed that nighttime BP, but not daytime BP significantly predicted CV mortality (P< or =0.05) and major CV events (P< or =0.01) after adjustment for office BP and other confounders. When both nighttime and daytime BP were entered into the models, the predictive power of nighttime BP remained significant (P< or =0.05); daytime BP did not add prognostic precision to nighttime BP. The systolic nightday BP ratio predicted all outcomes, and outcome was significantly worse in reverse dippers and nondippers than in dippers, both before and after adjustment for 24-h BP (P< or =0.05).
Nighttime BP is the better predictor of death and recurrent CV events in hypertensive patients with a history of CV disease. The night-day BP ratio and the dipping pattern significantly predict outcome, even after adjustment for 24-h BP.
评估基线时患有心血管疾病的患者夜间和日间血压（BP）、其比值以及夜间血压下降模式对死亡率和心血管（CV）事件复发的预后意义。
动态血压的预后价值在有心血管疾病病史的高血压患者中尚未见报道。
我们对来自欧洲进行的三项前瞻性研究的302例高血压和心血管疾病患者的个体数据进行了荟萃分析。
患者平均年龄为69±9岁；50%为男性，62%在进行动态血压监测时正在接受抗高血压治疗。诊室、日间和夜间血压平均分别为161±20/86±12、144±16/83±11和132±18/72±12 mmHg。总随访时间达2049患者-年。多变量Cox回归分析显示，在调整诊室血压和其他混杂因素后，夜间血压而非日间血压显著预测心血管死亡率（P≤0.05）和主要心血管事件（P≤0.01）。当将夜间和日间血压都纳入模型时，夜间血压的预测能力仍然显著（P≤0.05）；日间血压并未增加夜间血压的预后预测精度。收缩压夜间/日间血压比值可预测所有结局，在调整24小时血压前后，反勺型血压者和非勺型血压者的结局均显著差于勺型血压者（P≤0.05）。
在有心血管疾病病史的高血压患者中，夜间血压是死亡和心血管事件复发的更好预测指标。即使在调整24小时血压后，夜间/日间血压比值和血压下降模式仍能显著预测结局。
