Pierdomenico Sante D, Di Nicola Marta, Esposito Anna L, Di Mascio Rocco, Ballone Enzo, Lapenna Domenico, Cuccurullo Franco
Dipartimento di Medicina e Scienze dell'Invecchiamento, Università Gabriele d'Annunzio, Chieti, Italy.
Am J Hypertens. 2009 Aug;22(8):842-7. doi: 10.1038/ajh.2009.103. Epub 2009 Jun 4.
The independent prognostic significance of different indices of blood pressure (BP) variability is not clear. We investigated the prognostic value of BP variability estimated as s.d. or average real variability (ARV) of daytime and night time BP, in hypertensive patients.
The occurrence of fatal and nonfatal cardiovascular events was evaluated in 1,280 sequential hypertensive patients (550 initially untreated and 730 initially treated) aged > or =40 years. Subjects with s.d. or ARV of daytime or night time systolic or diastolic BP below or above the median were classified as having low or high BP variability.
During the follow-up (4.75 +/- 1.8 years), 104 cardiovascular events occurred. The event rate per 100 patient-years was 1.71 in the global population. After adjustment for other covariates, Cox regression analysis showed that cardiovascular risk was higher in subjects with high ARV of daytime systolic BP in initially untreated, initially treated, and all the subjects (high vs. low ARV, hazard ratio (HR) 2.29 (1.06-4.94), HR 1.90 (1.06-3.39), and HR 2.07 (1.31-3.28), respectively). ARV of daytime diastolic BP and night time BP, and s.d. of daytime and night time BP were not significantly associated with risk or were not independent predictors of outcome.
In this study, high ARV of daytime systolic BP resulted in an independent predictor of cardiovascular risk in hypertensive patients, while high s.d. did not. Our data suggest that, in comparison to s.d., ARV could be a more appropriate index of BP variability and a more useful predictor of outcomes.
血压（BP）变异性不同指标的独立预后意义尚不清楚。我们研究了以日间和夜间血压的标准差（s.d.）或平均实际变异性（ARV）估计的BP变异性在高血压患者中的预后价值。
对1280例年龄≥40岁的连续性高血压患者（550例初治患者和730例初治后患者）发生致命和非致命心血管事件的情况进行评估。将日间或夜间收缩压或舒张压的s.d.或ARV低于或高于中位数的受试者分类为具有低或高BP变异性。
在随访期间（4.75±1.8年），发生了104例心血管事件。全球人群中每100患者年的事件发生率为1.71。在对其他协变量进行调整后，Cox回归分析显示，在初治、初治后以及所有受试者中，日间收缩压ARV高的受试者心血管风险更高（高ARV与低ARV相比，风险比（HR）分别为2.29（1.06 - 4.94）、1.90（1.06 - 3.39）和2.07（1.31 - 3.28））。日间舒张压和夜间血压的ARV以及日间和夜间血压的s.d.与风险无显著相关性或不是结局的独立预测因素。
在本研究中，日间收缩压的高ARV是高血压患者心血管风险的独立预测因素，而高s.d.则不是。我们的数据表明，与s.d.相比，ARV可能是更合适的BP变异性指标和更有用的结局预测因素。
