Fagard R H, Thijs L, Staessen J A, Clement D L, De Buyzere M L, De Bacquer D A
Hypertension and Cardiovascular Rehabilitation Unit, Faculty of Medicine, University of Leuven, Leuven, Belgium.
J Hum Hypertens. 2009 Oct;23(10):645-53. doi: 10.1038/jhh.2009.9. Epub 2009 Feb 19.
Our objective was to assess the prognostic significance of the night-time dipping pattern and the night-day blood pressure (BP) ratio for mortality and cardiovascular events in hypertensive patients without major cardiovascular disease at baseline. We performed a meta-analysis on individual data of 3468 patients from four prospective studies performed in Europe. Age of the subjects averaged 61+/-13 years; 45% were men and 61% were under antihypertensive treatment at the time of ambulatory BP monitoring. The night-day BP ratio and 24-h BP averaged, respectively, 0.907+/-0.085/0.866+/-0.095 and 138.1+/-16.4/82.3+/-11.0 mm Hg. Total follow-up time amounted to 23 164 patient-years. We used multivariable Cox regression analysis to assess the outcome of reverse dippers, non-dippers and extreme dippers vs dippers, and to assess the hazard ratios associated with 1 standard deviation higher night-day BP ratio. In comparison with dippers, and with adjustment for confounders and 24-h BP, the incidence of cardiovascular events was worse in reverse dippers (P<or=0.05), whereas mortality was lower in extreme dippers (P<or=0.01); outcome was similar in non-dippers and dippers. The systolic night-day BP ratio independently predicted all-cause mortality and cardiovascular events (P<or=0.001), which persisted after additional adjustment for 24-h BP (P<or=0.05); appropriate interaction terms indicated that the results were similar in men and women, in younger and older patients and in treated and untreated patients. In conclusion, the dipping pattern and the night-day BP ratio significantly and independently predict mortality and cardiovascular events in hypertensive patients without history of major cardiovascular disease, even after adjustment for 24-h BP.
我们的目标是评估夜间血压下降模式和夜间与日间血压（BP）比值对基线时无重大心血管疾病的高血压患者死亡率和心血管事件的预后意义。我们对欧洲进行的四项前瞻性研究中3468例患者的个体数据进行了荟萃分析。受试者的平均年龄为61±13岁；45%为男性，61%在进行动态血压监测时正在接受抗高血压治疗。夜间与日间血压比值和24小时平均血压分别为0.907±0.085/0.866±0.095和138.1±16.4/82.3±11.0 mmHg。总随访时间达23164患者年。我们使用多变量Cox回归分析来评估反勺型、非勺型和极端勺型与勺型相比的结局，并评估与夜间与日间血压比值升高1个标准差相关联的风险比。与勺型相比，在对混杂因素和24小时血压进行校正后，反勺型患者的心血管事件发生率更高（P≤0.05），而极端勺型患者的死亡率更低（P≤0.01）；非勺型和勺型患者的结局相似。收缩压夜间与日间血压比值独立预测全因死亡率和心血管事件（P≤0.001），在对24小时血压进行额外校正后该结果仍然存在（P≤0.05）；适当的交互项表明，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结果相似。总之，即使在对24小时血压进行校正后，血压下降模式和夜间与日间血压比值仍能显著且独立地预测无重大心血管疾病病史的高血压患者的死亡率和心血管事件。
