Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Am J Hypertens. 2011 Jul;24(7):796-801. doi: 10.1038/ajh.2011.58. Epub 2011 Apr 14.
Morning blood pressure surge (MS) is accepted to increase cardiovascular risk, but it is not clear how it should be defined. Because dipping on 24-h ambulatory blood pressure monitoring (ABPM) associates with improved outcome we hypothesized that MS will not predict mortality independent of dipping.
We investigated a cohort of 2,627 patients referred for ABPM with available values for at least 1-h after awakening, and related them to all-cause mortality.
During 22,353 person-years of follow-up, 246 patients died. We used Cox proportional hazards models to explore mortality associated with different definitions of the MS. Only the "1-h" MS (difference between average blood pressure (BP) 1-h before and after awakening) was related to mortality: after multiple adjustments including 24-h systolic BP, those whose "1-h" MS was above median (>12 mm Hg) had mortality hazard ratio (HR) of 0.61, 95% CI: 0.47-0.79, P < 0.001. In predetermined subgroup analyses, nondippers (n = 1,039), had a highly significant MS-related decrease in mortality: HR 0.49, 95% CI: 0.34-0.73, P < 0.001, unlike dippers (n = 1,588), HR = 0.90, 95% CI: 0.60-1.34.
Among nondipping subjects referred for ABPM, the MS is associated with decreased mortality.
清晨血压飙升（MS）被认为会增加心血管风险，但目前尚不清楚应如何定义。由于 24 小时动态血压监测（ABPM）中的下降与改善预后相关，我们假设 MS 不会独立于下降预测死亡率。
我们调查了一个接受 ABPM 检查的 2627 例患者队列，这些患者至少有一次在醒来后 1 小时内有可测量的血压值，并将他们与全因死亡率相关联。
在 22353 人年的随访期间，有 246 例患者死亡。我们使用 Cox 比例风险模型来探讨与不同 MS 定义相关的死亡率。只有“1 小时”MS（觉醒前后平均血压（BP）的 1 小时差异）与死亡率相关：在包括 24 小时收缩压在内的多次调整后，那些“1 小时”MS 高于中位数（>12mmHg）的患者的死亡率风险比（HR）为 0.61，95%CI：0.47-0.79，P<0.001。在预定的亚组分析中，非杓型（n=1039）患者的 MS 与死亡率显著降低相关：HR 0.49，95%CI：0.34-0.73，P<0.001，而杓型（n=1588）患者的 HR 为 0.90，95%CI：0.60-1.34。
在接受 ABPM 检查的非杓型患者中，MS 与死亡率降低相关。
