Madden J M, O'Flynn A M, Dolan E, Fitzgerald A P, Kearney P M
Department of Epidemiology and Public Health, University College Cork, Cork City, Ireland.
Stroke and Hypertension unit, Connolly Hospital, Blanchardstown, Dublin, Ireland.
J Hum Hypertens. 2015 Dec;29(12):719-25. doi: 10.1038/jhh.2015.18. Epub 2015 Mar 19.
Blood pressure variability (BPV) has been associated with cardiovascular events; however, the prognostic significance of short-term BPV remains uncertain. As uncertainty also remains as to which measure of variability most accurately describes short-term BPV, this study explores different indices and investigates their relationship with subclinical target organ damage (TOD). We used data from the Mitchelstown Study, a cross-sectional study of Irish adults aged 47-73 years (n=2047). A subsample (1207) underwent 24-h ambulatory BP monitoring (ABPM). As measures of short-term BPV, we estimated the s.d., weighted s.d. (wSD), coefficient of variation (CV) and average real variability (ARV). TOD was documented by microalbuminuria and electrocardiogram (ECG) left ventricular hypertrophy (LVH). There was no association found between any measure of BPV and LVH in both unadjusted and fully adjusted logistic regression models. Similar analysis found that ARV (24 h, day and night), s.d. (day and night) and wSD were all univariately associated with microalbuminuria and remained associated after adjustment for age, gender, smoking, body mass index (BMI), diabetes and antihypertensive treatment. However, when the models were further adjusted for the mean BP the association did not persist for all indices. Our findings illustrate choosing the appropriate summary measure, which accurately captures that short-term BPV is difficult. Despite discrepancies in values between the different measures, there was no association between any indexes of variability with TOD measures after adjustment for the mean BP.
血压变异性(BPV)与心血管事件相关;然而,短期BPV的预后意义仍不明确。由于关于哪种变异性测量方法能最准确地描述短期BPV也存在不确定性,本研究探讨了不同指标,并研究了它们与亚临床靶器官损害(TOD)的关系。我们使用了米切尔斯敦研究的数据,这是一项对47至73岁爱尔兰成年人的横断面研究(n = 2047)。一个子样本(1207人)接受了24小时动态血压监测(ABPM)。作为短期BPV的测量指标,我们估计了标准差(s.d.)、加权标准差(wSD)、变异系数(CV)和平均实际变异性(ARV)。通过微量白蛋白尿和心电图(ECG)左心室肥厚(LVH)记录TOD。在未调整和完全调整的逻辑回归模型中,未发现任何BPV测量指标与LVH之间存在关联。类似分析发现,ARV(24小时、白天和夜间)、s.d.(白天和夜间)和wSD在单变量分析中均与微量白蛋白尿相关,在调整年龄、性别、吸烟、体重指数(BMI)、糖尿病和抗高血压治疗后仍保持相关。然而,当模型进一步调整平均血压后,并非所有指标的关联都持续存在。我们的研究结果表明,选择合适的汇总测量指标来准确捕捉短期BPV是困难的。尽管不同测量指标的值存在差异,但在调整平均血压后,任何变异性指标与TOD测量指标之间均无关联。