Skoglund Per H, Östergren Jan, Svensson Per
Karolinska University Hospital Solna, Department of Emergency Medicine, Stockholm, Sweden.
Blood Press. 2012 Aug;21(4):227-32. doi: 10.3109/00365599.2012.676755. Epub 2012 May 4.
Patients with peripheral arterial disease (PAD) are at high risk of cardiovascular (CV) events and often have hypertension with a high pulse pressure (PP). We studied the prognostic value of ambulatory blood pressure (ABP) in PAD patients with special reference to PP.
98 consecutive males with PAD had 24-h ABP measurements. The mean age was 68 years and CV comorbidity was prevalent. The outcome variable was CV events defined as CV mortality or any hospitalization for myocardial infarction, stroke or coronary revascularization. The predictive value of ABP variables was assessed by Cox regression. 90 age-matched men free of CV disease served as controls.
During follow-up (median 71 months), 36 patients and seven controls had at least one CV event. In PAD patients, 24-h PP (hazard ratios, HR, 1.48 (95% confidence interval, CI, 1.14-1.92), p <0.01) predicted CV events. Office PP did not predict events in PAD patients (HR 1.15 (0.97-1.38), ns). In multivariate analysis, 24-h PP (HR 1.48 (1.12-1.95), p <0.01) remained a predictor of CV events.
Ambulatory PP predicts CV events in patients with PAD. ABP measurement may be indicated for better risk stratification in PAD patients.
外周动脉疾病（PAD）患者发生心血管（CV）事件的风险很高，且常伴有高血压和高脉压（PP）。我们研究了动态血压（ABP）在PAD患者中的预后价值，特别关注脉压。
对98例连续的男性PAD患者进行了24小时ABP测量。平均年龄为68岁，心血管合并症很常见。结局变量为CV事件，定义为CV死亡率或因心肌梗死、中风或冠状动脉血运重建而住院。通过Cox回归评估ABP变量的预测价值。90名年龄匹配的无心血管疾病男性作为对照。
在随访期间（中位时间71个月），36例患者和7例对照至少发生了一次CV事件。在PAD患者中，24小时脉压（风险比，HR为1.48（95%置信区间，CI为1.14-1.92），p<0.01）可预测CV事件。诊室脉压不能预测PAD患者的事件（HR为1.15（0.97-1.38），无显著性差异）。在多变量分析中，24小时脉压（HR为1.48（1.12-1.95），p<0.01）仍然是CV事件的预测因子。
动态脉压可预测PAD患者的CV事件。对于PAD患者，测量ABP可能有助于更好地进行风险分层。
