Clinica Medica and Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy.
Circulation. 2012 Jul 31;126(5):569-78. doi: 10.1161/CIRCULATIONAHA.112.107565. Epub 2012 Jul 3.
In high-cardiovascular-risk treated hypertensive patients, the incidence of cardiovascular events has been reported to relate to visit-to-visit blood pressure (BP) variability. We investigated whether visit-to-visit BP variability is prognostically important in treated mildly to moderately hypertensive patients in whom treatment aims at avoiding events but also at preventing or delaying progression of organ damage.
We analyzed the pooled data from the European Lacidipine Study on Atherosclerosis (ELSA), a randomized, double-blind 4-year trial of the effect of lacidipine or atenolol on echographic carotid intima-media thickness. Visit-to-visit BP variability was assessed by the coefficient of variation or the SD of the mean on-treatment systolic BP (SBP) obtained at 6- (clinic BP) and 12- (24 hours BP) month intervals, respectively (1521 and 1264 patients, respectively). In a multivariable linear regression model, mean on-treatment clinic or 24-hour SBP, but not SBP coefficient of variation or SD, was associated with end-of-treatment carotid intima-media thickness. Intima-media thickness increased progressively from the lowest to highest quartile of mean on-treatment clinic or 24-hour SBP (adjusted P for trend=0.046 and 0.048) but not along similar quartiles of SBP coefficient of variation or SD. In a multivariable logistic regression model, mean BP, but not variability, was associated with cardiovascular outcomes.
In mildly to moderately hypertensive patients, carotid intima-media thickness and cardiovascular outcomes were related to the mean clinic or ambulatory SBP achieved by treatment but not to on-treatment visit-to-visit clinic or 24-hour BP variability. Thus, when BP is modestly elevated, inconsistency of BP control between visits plays a less important prognostic role than long-term average BP levels.
在心血管风险较高的高血压治疗患者中，心血管事件的发生率与随访间血压（BP）变异性有关。我们研究了在接受治疗的轻度至中度高血压患者中，BP 变异性是否具有预后意义，这些患者的治疗目的是避免事件发生，同时预防或延迟器官损伤的进展。
我们分析了欧洲拉西地平动脉粥样硬化研究（ELSA）的汇总数据，这是一项为期 4 年的随机、双盲试验，研究了拉西地平或阿替洛尔对超声颈动脉内膜中层厚度的影响。通过治疗期间收缩压（SBP）的均值变异系数或标准差来评估随访间 BP 变异性，该 SBP 分别在 6 个月（诊所 BP）和 12 个月（24 小时 BP）间隔时间内获得（分别为 1521 例和 1264 例患者）。在多变量线性回归模型中，治疗期间的平均诊所或 24 小时 SBP，但不是 SBP 变异系数或标准差，与治疗结束时颈动脉内膜中层厚度相关。从最低到最高四分位数的治疗期间平均诊所或 24 小时 SBP ，内膜中层厚度逐渐增加（趋势调整 P 值分别为 0.046 和 0.048），但类似的 SBP 变异系数或标准差四分位数则没有。在多变量逻辑回归模型中，平均 BP，但不是变异性，与心血管结局相关。
在轻度至中度高血压患者中，颈动脉内膜中层厚度和心血管结局与治疗期间达到的平均诊所或动态 SBP 相关，但与治疗期间的随访间诊所或 24 小时 BP 变异性无关。因此，当 BP 适度升高时，BP 控制在就诊之间的不一致性比长期平均 BP 水平对预后的作用要小。
