Li Yan, Thijs Lutgarde, Boggia José, Asayama Kei, Hansen Tine W, Kikuya Masahiro, Björklund-Bodegård Kristina, Ohkubo Takayoshi, Jeppesen Jørgen, Torp-Pedersen Christian, Dolan Eamon, Kuznetsova Tatiana, Stolarz-Skrzypek Katarzyna, Tikhonoff Valérie, Malyutina Sofia, Casiglia Edoardo, Nikitin Yuri, Lind Lars, Sandoya Edgardo, Kawecka-Jaszcz Kalina, Filipovsky Jan, Imai Yutaka, Ibsen Hans, O'Brien Eoin, Wang Jiguang, Staessen Jan A
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, block D, Box 7001, BE-3000 Leuven, Belgium.
Hypertension. 2014 May;63(5):925-33. doi: 10.1161/HYPERTENSIONAHA.113.02780. Epub 2014 Feb 17.
Experts proposed blood pressure (BP) load derived from 24-hour ambulatory BP recordings as a more accurate predictor of outcome than level, in particular in normotensive people. We analyzed 8711 subjects (mean age, 54.8 years; 47.0% women) randomly recruited from 10 populations. We expressed BP load as percentage (%) of systolic/diastolic readings ≥135/≥85 mm Hg and ≥120/≥70 mm Hg during day and night, respectively, or as the area under the BP curve (mm Hg×h) using the same ceiling values. During a period of 10.7 years (median), 1284 participants died and 1109 experienced a fatal or nonfatal cardiovascular end point. In multivariable-adjusted models, the risk of cardiovascular complications gradually increased across deciles of BP level and load (P<0.001), but BP load did not substantially refine risk prediction based on 24-hour systolic or diastolic BP level (generalized R(2) statistic ≤0.294%; net reclassification improvement ≤0.28%; integrated discrimination improvement ≤0.001%). Systolic/diastolic BP load of 40.0/42.3% or 91.8/73.6 mm Hg×h conferred a 10-year risk of a composite cardiovascular end point similar to a 24-hour systolic/diastolic BP of 130/80 mm Hg. In analyses dichotomized according to these thresholds, increased BP load did not refine risk prediction in the whole study population (R(2)≤0.051) or in untreated participants with 24-hour ambulatory normotension (R(2)≤0.034). In conclusion, BP load does not improve risk stratification based on 24-hour BP level. This also applies to subjects with normal 24-hour BP for whom BP load was proposed to be particularly useful in risk stratification.
专家们提出，源自24小时动态血压记录的血压（BP）负荷比血压水平更能准确预测结果，尤其对于血压正常的人群。我们分析了从10个群体中随机招募的8711名受试者（平均年龄54.8岁；47.0%为女性）。我们将血压负荷表示为白天和夜间收缩压/舒张压读数≥135/≥85 mmHg和≥120/≥70 mmHg的百分比（%），或者使用相同的上限值表示为血压曲线下的面积（mmHg×h）。在10.7年（中位数）期间，1284名参与者死亡，1109名经历了致命或非致命的心血管终点事件。在多变量调整模型中，心血管并发症的风险随着血压水平和负荷的十分位数逐渐增加（P<0.001），但血压负荷并没有在基于24小时收缩压或舒张压水平的风险预测上有实质性的改进（广义R(2)统计量≤0.294%；净重新分类改善≤0.28%；综合判别改善≤0.001%）。收缩压/舒张压负荷为40.0/42.3%或91.8/73.6 mmHg×h时，10年复合心血管终点事件的风险与24小时收缩压/舒张压为130/80 mmHg时相似。在根据这些阈值进行二分法分析中，血压负荷增加并没有在整个研究人群（R(2)≤0.051）或24小时动态血压正常的未治疗参与者（R(2)≤0.034）中改善风险预测。总之，血压负荷并不能基于24小时血压水平改善风险分层。这也适用于24小时血压正常的受试者，对于他们，血压负荷曾被认为在风险分层中特别有用。
