Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA.
J Clin Hypertens (Greenwich). 2012 Mar;14(3):165-71. doi: 10.1111/j.1751-7176.2011.00581.x. Epub 2012 Jan 24.
The association between within-visit variability of systolic blood pressure (SBP) and diastolic blood pressure (DBP) and all-cause and cardiovascular (CVD) mortality was examined using the Third National Health and Nutrition Survey (n=15,317). Three SBP and DBP readings were taken by physicians during a single medical evaluation. Within-visit variability for each participant was defined using the standard deviation of SBP and DBP across these measurements. Mortality was assessed over 14 years (n=3848 and n=1684 deaths from all causes and CVD, respectively). After age, sex, and race-ethnicity adjustment, the hazard ratios (95% confidence intervals) for all-cause mortality associated with the 4 highest quintiles of within-visit standard deviation of SBP (2.00-2.99 mm Hg, 3.00-3.99 mm Hg, 4.00-5.29 mm Hg, and ≥5.30 mm Hg) compared with participants in the lowest quintile of within-visit standard deviation of SBP (<2.0 mm Hg) were 1.04 (0.87-1.26), 1.09 (0.92-1.29), 1.06 (0.88-1.28), and 1.13 (0.95-1.33), respectively (P=.136). The analogous hazard ratios for CVD mortality were 0.95 (0.69-1.32), 0.96 (0.67-1.36), 0.95 (0.74-1.23), and 1.04 (0.80-1.35), respectively (P=.566). No association with mortality was present after further adjustment and when modeling within-visit standard deviation of SBP as a continuous variable. Standard deviation of DBP was not associated with mortality.
利用第三次全国健康和营养调查（n=15317）数据，研究了收缩压（SBP）和舒张压（DBP）的就诊内变异性与全因和心血管（CVD）死亡率之间的关系。在单次医疗评估期间，医生会对三次 SBP 和 DBP 进行测量。通过对这些测量结果计算 SBP 和 DBP 的标准差，来定义每个参与者的就诊内变异性。在 14 年的随访期间（分别有 3848 人和 1684 人死于全因和 CVD），评估了死亡率。在调整年龄、性别和种族后，与就诊内 SBP 标准差最低五分位数（<2.0mm Hg）的参与者相比，就诊内 SBP 标准差处于第 4 高五分位数（2.00-2.99mmHg、3.00-3.99mmHg、4.00-5.29mmHg 和≥5.30mm Hg）的参与者的全因死亡率的风险比（95%置信区间）分别为 1.04（0.87-1.26）、1.09（0.92-1.29）、1.06（0.88-1.28）和 1.13（0.95-1.33）（P=.136）。类似地，CVD 死亡率的风险比分别为 0.95（0.69-1.32）、0.96（0.67-1.36）、0.95（0.74-1.23）和 1.04（0.80-1.35）（P=.566）。进一步调整和将就诊内 SBP 标准差建模为连续变量后，与死亡率没有关联。DBP 的标准差与死亡率无关。
