Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
1] Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium [2] Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
J Hum Hypertens. 2014 May;28(5):316-22. doi: 10.1038/jhh.2013.106. Epub 2013 Oct 24.
No longitudinal study addressed whether systolic blood pressure level (SBPL) or within-visit variability (SBPV) predict arterial properties or vice versa. In families randomly recruited from a Flemish population, we determined SBPL and SBPV from five consecutive blood pressure readings. The indexes of SBPV were variability independent of the mean, the difference between maximum and minimum SBPL, and average real variability. We measured carotid intima-media thickness and distensibility by ultrasound and carotid-femoral pulse wave velocity by tonometry (SphygmoCor, version 8.2). Effect sizes were computed for 1-s.d. increments in the predictors, while accounting for covariables and family clusters. Among 1087 participants (50.4% women; mean age, 41.8 years), followed up for 2.55 years (median), higher SBPL predicted (P < or = 0.019) higher carotid intima-media thickness (+15 μm), lower carotid distensibility (-1.53 10(-3) kPa(-1)) and faster carotid-femoral pulse wave velocity (+0.285 m s(-1)) at follow-up, whereas none of the SBPV indexes predicted the arterial traits at follow-up (P> or = 0.11). In a subset of 713 participants, followed up for another 3.14 years, lower carotid distensibility predicted (P<0.01) higher SBPL (+2.57 mm Hg), variability independent of the mean (+0.531 units), difference between maximum and minimum SBPL (+1.75 mm Hg) and average real variability (+0.654 mm Hg). Higher carotid-femoral pulse wave velocity predicted a 1.11 mm Hg increase SBPL (P=0.031). In conclusion, temporality and effect size suggest that SBPL but not within-visit SBPV cause arterial stiffness and carotid intima-media thickness. Carotid stiffness, independent of SBPL, predicts within-visit SBPV, possibly because baroreflexes originating from a stiff carotid artery wall are impaired. Finally, stiffness of the aorta contributes to the age-related SBPL possibly, because faster returning reflected waves augments SBPL.
尚无研究探讨收缩压水平（SBPL）或访间血压变异性（SBPV）能否预测动脉功能，反之亦然。我们从佛兰德人群中随机招募的家庭中，通过连续五次血压读数确定 SBPL 和 SBPV。SBPV 的指标包括：均值无关变异性、SBPL 最大值与最小值之差，以及平均实际变异性。我们通过超声测量颈动脉内膜-中层厚度和扩张性，通过脉搏波速度测量仪（SphygmoCor，版本 8.2）测量颈股脉搏波速度。计算出每个预测指标增加 1 个标准差的效应量，同时考虑协变量和家庭聚类。在 1087 名参与者（50.4%为女性；平均年龄 41.8 岁）中，中位随访时间为 2.55 年，随访时较高的 SBPL 预示着较高的颈动脉内膜-中层厚度（增加 15μm）、较低的颈动脉扩张性（减少 1.53×10(-3)kPa(-1)）和较快的颈股脉搏波速度（增加 0.285m·s(-1)）（P<0.019），而 SBPV 指标均不能预测随访时的动脉特征（P≥0.11）。在 713 名参与者的亚组中，中位随访时间为 3.14 年，随访时较低的颈动脉扩张性预示着较高的 SBPL（增加 2.57mmHg）、均值无关变异性（增加 0.531 个单位）、SBPL 最大值与最小值之差（增加 1.75mmHg）和平均实际变异性（增加 0.654mmHg）（P<0.01）。较高的颈股脉搏波速度预示着 SBPL 增加 1.11mmHg（P=0.031）。总之，时间顺序和效应大小表明，是 SBPL 而不是访间 SBPV 导致动脉僵硬和颈动脉内膜-中层厚度增加。颈动脉僵硬独立于 SBPL 预测访间 SBPV，这可能是因为起源于僵硬颈动脉壁的压力反射受损。最后，主动脉僵硬可能导致与年龄相关的 SBPL 增加，因为更快返回的反射波会增加 SBPL。
