血压变异性、收缩压最大值和偶发性高血压的预后意义。

Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension.

机构信息

Stroke Prevention Research Unit, University Department of Clinical Neurology, John Radcliffe Hospital, Headington, Oxford, UK.

出版信息

Lancet. 2010 Mar 13;375(9718):895-905. doi: 10.1016/S0140-6736(10)60308-X.

DOI:10.1016/S0140-6736(10)60308-X

PMID:20226988

Abstract

BACKGROUND

The mechanisms by which hypertension causes vascular events are unclear. Guidelines for diagnosis and treatment focus only on underlying mean blood pressure. We aimed to reliably establish the prognostic significance of visit-to-visit variability in blood pressure, maximum blood pressure reached, untreated episodic hypertension, and residual variability in treated patients.

METHODS

We determined the risk of stroke in relation to visit-to-visit variability in blood pressure (expressed as standard deviation [SD] and parameters independent of mean blood pressure) and maximum blood pressure in patients with previous transient ischaemic attack (TIA; UK-TIA trial and three validation cohorts) and in patients with treated hypertension (Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm [ASCOT-BPLA]). In ASCOT-BPLA, 24-h ambulatory blood-pressure monitoring (ABPM) was also studied.

FINDINGS

In each TIA cohort, visit-to-visit variability in systolic blood pressure (SBP) was a strong predictor of subsequent stroke (eg, top-decile hazard ratio [HR] for SD SBP over seven visits in UK-TIA trial: 6.22, 95% CI 4.16-9.29, p<0.0001), independent of mean SBP, but dependent on precision of measurement (top-decile HR over ten visits: 12.08, 7.40-19.72, p<0.0001). Maximum SBP reached was also a strong predictor of stroke (HR for top-decile over seven visits: 15.01, 6.56-34.38, p<0.0001, after adjustment for mean SBP). In ASCOT-BPLA, residual visit-to-visit variability in SBP on treatment was also a strong predictor of stroke and coronary events (eg, top-decile HR for stroke: 3.25, 2.32-4.54, p<0.0001), independent of mean SBP in clinic or on ABPM. Variability on ABPM was a weaker predictor, but all measures of variability were most predictive in younger patients and at lower (<median) values of mean SBP in every cohort.

INTERPRETATION

Visit-to-visit variability in SBP and maximum SBP are strong predictors of stroke, independent of mean SBP. Increased residual variability in SBP in patients with treated hypertension is associated with a high risk of vascular events.

FUNDING

None.

摘要

背景

高血压导致血管事件的机制尚不清楚。诊断和治疗指南仅关注基础平均血压。我们旨在可靠地确定血压随访间变异性、最大血压、未治疗的偶发性高血压和治疗患者残留变异性的预后意义。

方法

我们确定了与血压随访间变异性（表示为标准差[SD]和独立于平均血压的参数）和既往短暂性脑缺血发作（TIA；英国 TIA 试验和三个验证队列）患者的最大血压以及接受治疗的高血压患者（盎格鲁-斯堪的纳维亚心脏结局试验降压臂[ASCOT-BPLA]）相关的中风风险。在 ASCOT-BPLA 中，还研究了 24 小时动态血压监测（ABPM）。

结果

在每个 TIA 队列中，收缩压（SBP）的随访间变异性是随后中风的强预测因素（例如，英国 TIA 试验中七个随访期间 SD SBP 的最高十分位数危险比[HR]：6.22，95%CI 4.16-9.29，p<0.0001），独立于平均 SBP，但依赖于测量精度（十个随访期间的最高十分位数 HR：12.08，7.40-19.72，p<0.0001）。达到的最大 SBP 也是中风的强预测因素（七个随访期间最高十分位数 HR：15.01，6.56-34.38，p<0.0001，校正平均 SBP 后）。在 ASCOT-BPLA 中，治疗期间 SBP 的残留随访间变异性也是中风和冠心病事件的强预测因素（例如，中风的最高十分位数 HR：3.25，2.32-4.54，p<0.0001），独立于诊所或 ABPM 中的平均 SBP。ABPM 上的变异性是一个较弱的预测因素，但在每个队列中，所有变异性测量在年轻患者和平均 SBP 较低（中位数以下）值时最具预测性。