Department of Internal Medicine, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, Genoa, Italy.
J Hum Hypertens. 2013 Nov;27(11):663-70. doi: 10.1038/jhh.2013.45. Epub 2013 Jun 6.
Organ damage (OD) is an indicator of increased cardiovascular risk. Blood pressure variability (BPV) is related to greater incidence of events, regardless of the severity of hypertension. We investigated the relationship between ambulatory blood pressure monitoring (ABPM)-derived indices of BPV and the presence of multiple OD in primary hypertension (PH). One hundred and sixty-nine untreated patients with PH were evaluated. Systolic (SBP) and diastolic blood pressure (DBP) variability were assessed as the crude and weighted (w.) standard deviation (s.d.), and average real variability (ARV) of the mean value of 24-h, awake and asleep ABPM recordings. Left ventricular mass index, intima-media thickness, estimated-glomerular filtration rate and urinary albumin excretion were assessed as indices of cardiac, vascular and renal damage, respectively. Risk profile progressively increased starting from patients without OD to patients with only one sign of OD, and then to those with multiple OD. In addition to greater severity of the organ involvement, the only variables that were found to significantly differ between subjects with multiple and single OD were office SBP (160 ± 14 vs 154 ± 11 mm Hg, P=0.0423) and DBP (101 ± 7 vs 97 ± 8 mm Hg, P=0.0291), ambulatory arterial stiffness index (AASI) (0.60 ± 0.10 vs 0.50 ± 0.17, P=0.0158) and indices of BPV (24-h SBP s.d., 23 ± 5 vs 20 ± 6 mm Hg, P=0.0300; awake SBP s.d., 22 ± 6 vs 19 ± 6 mm Hg, P=0.0366; 24-h SBP w.s.d., 20 ± 5 vs 17 ± 5 mm Hg, P=0.0385; and 24-h SBP ARV, 18 ± 4 vs 15 ± 5 mm Hg, P=0.0420). All the above mentioned BPV parameters turned out to be determinants of multiple OD, regardless of several confounding variables, including BP levels. Therefore, in hypertensive patients increased SBP variability is associated with multiple signs of OD, regardless of BP values.
器官损伤（OD）是心血管风险增加的指标。血压变异性（BPV）与更大的事件发生率有关，而与高血压的严重程度无关。我们研究了原发性高血压（PH）患者的动态血压监测（ABPM）衍生的 BPV 指标与多种 OD 存在之间的关系。评估了 169 名未经治疗的 PH 患者。评估了收缩压（SBP）和舒张压（DBP）变异性的原始标准差（s.d.）和加权标准差（w.s.d.），以及 24 小时、清醒和睡眠 ABPM 记录平均值的平均真实变异性（ARV）。左心室质量指数、内中膜厚度、估计肾小球滤过率和尿白蛋白排泄分别评估为心脏、血管和肾脏损伤的指标。风险谱从无 OD 的患者开始逐渐增加，到只有一个 OD 迹象的患者，再到有多个 OD 的患者。除了器官受累程度更大外，在仅有单一 OD 迹象的患者和具有多个 OD 的患者之间，唯一发现差异显著的变量是诊室 SBP（160±14 比 154±11 mm Hg，P=0.0423）和 DBP（101±7 比 97±8 mm Hg，P=0.0291）、动脉僵硬度指数（AASI）（0.60±0.10 比 0.50±0.17，P=0.0158）和 BPV 指数（24 小时 SBP s.d.，23±5 比 20±6 mm Hg，P=0.0300；清醒 SBP s.d.，22±6 比 19±6 mm Hg，P=0.0366；24 小时 SBP w.s.d.，20±5 比 17±5 mm Hg，P=0.0385；24 小时 SBP ARV，18±4 比 15±5 mm Hg，P=0.0420）。所有上述 BPV 参数均为多器官损伤的决定因素，与包括血压水平在内的多个混杂变量无关。因此，在高血压患者中，SBP 变异性增加与多种 OD 迹象有关，而与血压值无关。
