Barochiner Jessica, Aparicio Lucas S, Cuffaro Paula E, Rada Marcelo A, Morales Margarita S, Alfie José, Marin Marcos J, Galarza Carlos R, Waisman Gabriel D
Rev Fac Cien Med Univ Nac Cordoba. 2014;71(4):171-7.
The morning blood pressure (BP) rise entails a higher cardiovascular risk. Studies evaluating the association between home BP morning rise and target organ damage are scarce and almost exclusively based on Asians. The aim of our study was to characterize hypertensive patients with morning rise in home BP and to establish a possible association with left ventricular hypertrophy (LVH).
treated hypertensive patients ≥ 18 years underwent home BP measurements (duplicate measurements for 4 days in the morning, afternoon and evening), and completed a questionnaire regarding risk factors and history of cardiovascular disease. Medical records were reviewed to extract data from grams. A morning rise in systolic home BP was defined as a difference between morning and evening systolic BP averages ≥15 mmHg. Subjects were considered to have LVH if the left ventricular mass index was >95 g/m2 in women and >115 g/m2 in men. Variables identified as relevant predictors of home BP morning rise were entered into a multivariable logistic regression analysis model.
216 patients were included, mean age 68 (+13.3), 69.4% women and 99.1% Caucasians. The prevalence of BP morning rise was 13.4% and independently associated factors were LVH (OR 3.5; 95%CI 1.1-11.4), age (OR 1.05; 95%CI 1.003-1.1) and a history of cerebrovascular disease (OR 3.9; 95%CI 1.1-14.2). In conclusion, a morning rise in systolic BP detected through home BP monitoring is independently associated with LVH, age and a history of cerebrovascular disease. The therapeutic implications of this observation need to be clarified in large-scale prospective studies.
早晨血压升高会带来更高的心血管风险。评估家庭血压早晨升高与靶器官损害之间关联的研究较少，且几乎都以亚洲人为研究对象。我们研究的目的是对家庭血压早晨升高的高血压患者进行特征描述，并确定其与左心室肥厚（LVH）之间可能存在的关联。
年龄≥18岁的接受治疗的高血压患者进行家庭血压测量（早晨、下午和晚上各重复测量4天），并完成一份关于危险因素和心血管疾病史的问卷。查阅病历以提取数据。家庭收缩压早晨升高定义为早晨和晚上收缩压平均值之差≥15 mmHg。如果女性左心室质量指数>95 g/m²，男性>115 g/m²，则认为受试者患有左心室肥厚。将确定为家庭血压早晨升高相关预测因素的变量纳入多变量逻辑回归分析模型。
纳入216例患者，平均年龄68（±13.3）岁，女性占69.4%，白种人占99.1%。血压早晨升高的患病率为13.4%，独立相关因素为左心室肥厚（比值比3.5；95%置信区间1.1 - 11.4）、年龄（比值比1.05；95%置信区间1.003 - 1.1）和脑血管疾病史（比值比3.9；95%置信区间1.1 - 14.2）。总之，通过家庭血压监测检测到的收缩压早晨升高与左心室肥厚、年龄和脑血管疾病史独立相关。这一观察结果的治疗意义需要在大规模前瞻性研究中加以阐明。
