From the Department of Medicine, University of Padova, Padua, Italy (P.P., E.C.); Department of Medicine, University of Perugia, Perugia, Italy (G.R.); School of Medicine and Pharmacology, University of Western Australia, Perth, Australia (L.J.B.); Department of Medicine, Jichi University, Tochigi, Japan (K.E., K.K.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University, Sendai, Japan (Y.I., T.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T.O.); Department of Medicine and Aging Science, University of Chieti, Chieti, Italy (S.D.P.); Division of General Medicine, Columbia University, New York, NY (J.E.S.); Department of Psychiatry, Stony Brook University, New York, NY (J.E.S.); School of Medicine, Flinders University, Adelaide, Australia (L.W.); and Unità operativa complessa di Medicina, Ospedale di Assisi, Italy (P.V.).
Hypertension. 2014 Sep;64(3):487-93. doi: 10.1161/HYPERTENSIONAHA.114.03694. Epub 2014 Jun 16.
The association of ambulatory blood pressure (BP) variability with mortality and cardiovascular events is controversial. To investigate whether BP variability predicts cardiovascular events and mortality in hypertension, we analyzed 7112 untreated hypertensive participants (3996 men) aged 52±15 years enrolled in 6 prospective studies. Median follow-up was 5.5 years. SD of night-time BP was positively associated with age, body mass index, smoking, diabetes mellitus, and average night-time BP (all P<0.001). In a multivariable Cox model, night-time BP variability was an independent predictor of all-cause mortality (systolic, P<0.001/diastolic, P<0.0001), cardiovascular mortality (P=0.008/<0.0001), and cardiovascular events (P<0.001/<0.0001). In contrast, daytime BP variability was not an independent predictor of outcomes in any model. In fully adjusted models, a night-time systolic BP SD of ≥12.2 mm Hg was associated with a 41% greater risk of cardiovascular events, a 55% greater risk of cardiovascular death, and a 59% increased risk of all-cause mortality compared with an SD of <12.2 mm Hg. The corresponding values for a diastolic BP SD of ≥7.9 mm Hg were 48%, 132%, and 77%. The addition of night-time BP variability to fully adjusted models had a significant impact on risk reclassification and integrated discrimination for all outcomes (relative integrated discrimination improvement for systolic BP variability: 9% cardiovascular events, 14.5% all-cause death, 8.5% cardiovascular death, and for diastolic BP variability: 10% cardiovascular events, 19.1% all-cause death, 23% cardiovascular death, all P<0.01). Thus, addition of BP variability to models of long-term outcomes improved the ability to stratify appropriately patients with hypertension among risk categories defined by standard clinical and laboratory variables.
动态血压（BP）变异性与死亡率和心血管事件的相关性存在争议。为了研究血压变异性是否可预测高血压患者的心血管事件和死亡率，我们分析了 6 项前瞻性研究中纳入的 7112 例未经治疗的高血压患者（3996 例男性）的资料，这些患者的年龄为 52±15 岁。中位随访时间为 5.5 年。夜间 BP 的标准差与年龄、体重指数、吸烟、糖尿病和平均夜间 BP 呈正相关（均 P<0.001）。在多变量 Cox 模型中，夜间 BP 变异性是全因死亡率（收缩压，P<0.001/舒张压，P<0.0001）、心血管死亡率（P=0.008/<0.0001）和心血管事件（P<0.001/<0.0001）的独立预测因素。相反，日间 BP 变异性在任何模型中均不是结局的独立预测因素。在完全校正模型中，夜间收缩压 SD≥12.2mmHg 与心血管事件风险增加 41%、心血管死亡风险增加 55%、全因死亡率风险增加 59%相关，与 SD<12.2mmHg 相比。舒张压 SD≥7.9mmHg 对应的数值分别为 48%、132%和 77%。将夜间 BP 变异性添加到完全校正模型中对风险再分类和所有结局的综合判别能力有显著影响（收缩压变异性的相对综合判别改善：心血管事件 9%，全因死亡 14.5%，心血管死亡 8.5%；舒张压变异性：心血管事件 10%，全因死亡 19.1%，心血管死亡 23%，均 P<0.01）。因此，将 BP 变异性添加到长期结局模型中可改善根据标准临床和实验室变量定义的风险类别对高血压患者进行适当分层的能力。
