O'Flynn Anne Marie, Dolan Eamon, Curtin Ronan J, O'Brien Eoin, Perry Ivan J, Kearney Patricia M
aDepartment of Epidemiology and Public Health, University College Cork, Western Road, Cork bDepartment of Geriatrics, Connolly Hospital, Blanchardstown, Dublin cDepartment of Cardiology, Cork University Hospital, Wilton, Cork dConway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.
J Hypertens. 2015 Nov;33(11):2257-64. doi: 10.1097/HJH.0000000000000690.
The prognostic significance of abnormal circadian blood pressure (BP) patterns is well established. Research to date has focused on both nocturnal dipping and absolute night-time BP levels; however, which of these variables should be the primary target for therapy remains unclear. The aim of this study is to determine whether dipping status or absolute night-time BP levels have a stronger association with subclinical target organ damage (TOD).
The Mitchelstown Cohort was established to examine cardiovascular health in an adult population sample recruited from primary care. Night-time BP was categorized by dipping status. Subclinical TOD was defined as Cornell Product left ventricular hypertrophy (LVH) voltage criteria on ECG and urine albumin : creatinine ratio (ACR) at least 1.1 mg/mmol. Multivariable logistic regression analysis was used to assess the association between night-time BP and TOD.
Of 2047 participants, 1207 (response rate 59%), underwent 24-h ambulatory BP monitoring. We excluded 161 studies due to incomplete data. Of 1046 participants, 178 (17%) had evidence of TOD. Each 10-mmHg rise in night-time SBP increased the odds of TOD. Odds ratio (OR) ACR at least 1.1 mg/mmol 1.5 [95% confidence interval (95% CI) 1.2-1.8] and OR LVH 1.4 (95% CI 1.1-1.8).
Absolute BP level rather than dipping status may be a superior early marker of risk associated with night-time BP. Interventional studies are required to determine whether there is a benefit in specifically targeting absolute night-time BP levels to prevent clinically important outcomes.
异常昼夜血压模式的预后意义已得到充分证实。迄今为止的研究主要集中在夜间血压下降情况和夜间绝对血压水平；然而，这些变量中哪一个应作为治疗的主要靶点仍不明确。本研究的目的是确定血压下降状态或夜间绝对血压水平与亚临床靶器官损害（TOD）的关联更强。
建立米切尔斯敦队列，以检查从初级保健机构招募的成年人群样本的心血管健康状况。夜间血压根据血压下降状态进行分类。亚临床TOD定义为心电图上符合康奈尔乘积左心室肥厚（LVH）电压标准以及尿白蛋白：肌酐比值（ACR）至少为1.1 mg/mmol。采用多变量逻辑回归分析来评估夜间血压与TOD之间的关联。
在2047名参与者中，1207名（应答率59%）接受了24小时动态血压监测。由于数据不完整，我们排除了161项研究。在1046名参与者中，178名（17%）有TOD证据。夜间收缩压每升高10 mmHg，TOD的几率增加。ACR至少为1.1 mg/mmol的比值比（OR）为1.5 [95%置信区间（95%CI）1.2 - 1.8]，LVH的OR为1.4（95%CI 1.1 - 1.8）。
绝对血压水平而非血压下降状态可能是与夜间血压相关风险的更优早期标志物。需要进行干预性研究以确定专门针对夜间绝对血压水平进行治疗是否有益于预防具有临床重要意义的结局。
