Division of Nephrology and Hypertension, Case Western Reserve University, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, MetroHealth Medical Center, Cleveland, OH 44106, USA.
Ren Fail. 2010;32(9):1036-43. doi: 10.3109/0886022X.2010.510615.
Nighttime systolic blood pressure (BP) from ambulatory blood pressure monitoring (ABPM) is more predictive than clinic BP for cardiovascular disease, stroke, and death even after controlling for clinic BP. However, ABPM is expensive and burdensome to obtain regularly. BPs obtained in the hospital may provide a window into nighttime BP. We conducted a retrospective cohort study of all hypertensive patients admitted to the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC) in 2002 and 2003 with one or more BP recorded between midnight and 6 am on the day of or the day before discharge. The mean age of the study population (n = 1085) was 62 years and 96% were male. Twenty-two percent had coronary artery disease (CAD) and 34% had diabetes. The mean nighttime systolic BP was 132 mmHg and baseline glomerular filtration rate (GFR) was 83 mL/min per 1.73 m(2). Over a median follow-up period of 4.3 years, 266 subjects died, 22 developed end-stage renal disease (ESRD), 99 had a 50% decline in GFR, and 136 developed myocardial infarction (MI). The adjusted hazard ratios (HRs) associated with a 10 mmHg increase in nighttime systolic BP were 1.03 (95% confidence interval, 0.93-1.15) for death, 1.30 (0.94-1.80) for ESRD, 1.26 (1.08-1.47) for a 50% decline in GFR, 1.07 (0.92-1.23) for myocardial infarction, and 1.12 (1.03-1.23) for a composite of death, ESRD, or a 50% decline in GFR. In conclusion, nighttime systolic BP in hospitalized patients is an independent predictor of important clinical outcomes such as a composite of death, ESRD, or a 50% decline in GFR.
夜间动态血压（BP）与诊所 BP 相比，即使在控制诊所 BP 后，对心血管疾病、中风和死亡的预测性更高。然而，ABPM 昂贵且定期获取负担沉重。在医院获得的 BP 可能为夜间 BP 提供一个窗口。我们对 2002 年和 2003 年在路易斯·斯托克斯克利夫兰退伍军人事务医疗中心（LSCDVAMC）住院的所有高血压患者进行了一项回顾性队列研究，这些患者在出院当天或前一天的午夜至早上 6 点之间记录了一次或多次 BP。研究人群的平均年龄（n = 1085）为 62 岁，96%为男性。22%有冠状动脉疾病（CAD），34%有糖尿病。夜间收缩压的平均值为 132mmHg，基线肾小球滤过率（GFR）为 83mL/min/1.73m(2)。在中位随访期为 4.3 年期间，有 266 名患者死亡，22 名患者发展为终末期肾病（ESRD），99 名患者 GFR 下降 50%，136 名患者发生心肌梗死（MI）。夜间收缩压每增加 10mmHg，与以下结果相关的校正危害比（HR）分别为：死亡 1.03（95%置信区间，0.93-1.15），ESRD 1.30（0.94-1.80），GFR 下降 50%1.26（1.08-1.47），心肌梗死 1.07（0.92-1.23），以及死亡、ESRD 或 GFR 下降 50%的复合结果 1.12（1.03-1.23）。总之，住院患者的夜间收缩压是死亡、ESRD 或 GFR 下降 50%等重要临床结局的独立预测因素。
