Hsu Pai-Feng, Cheng Hao-Min, Wu Cheng-Hsueh, Sung Shih-Hsien, Chuang Shao-Yuan, Lakatta Edward G, Yin Frank C P, Chou Pesus, Chen Chen-Huan
Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan;
National Health Research Institutes, Miaoli, Taiwan;
Am J Hypertens. 2016 Jul;29(7):806-13. doi: 10.1093/ajh/hpw002. Epub 2016 Feb 1.
The prognostic value of the short-term blood pressure variability (BPV) from the 24-hour ambulatory blood pressure monitoring (ABPM) remains controversial. The present study aimed to investigate the long-term prognostic value of a high BPV in normotensive and hypertensive subjects from a community-based population.
A cohort of 624 normotensive and 633 untreated hypertensive Taiwanese participants (overall 669 men, aged 30-79 years) with baseline ABPM and 20-year all-cause and cardiovascular mortality data was drawn from a community-based survey. BPV was assessed by the read-to-read average real variability of the 24-hour diastolic and systolic blood pressure (SBP) (ARVd and ARVs, respectively).
In Cox proportional hazards analysis, ARVd predicted cardiovascular mortality independently of office SBP (hazard ratios (HRs) and 95% confidence intervals (CIs) per 1 SD: 1.31 (1.10-1.55), respectively, bivariate analysis), 24-hour SBP (HR: 1.19, 95% CI: 1.00-1.43), and conventional risk factors (age, sex, smoking, total cholesterol, high-density lipoprotein cholesterol, and fasting blood glucose, HR: 1.40, 95% CI: 1.18-1.67). In subjects with hypertension, a high vs. low ARVd (median: 8.8mm Hg) significantly predicted cardiovascular mortality (HR: 2.11, 95% CI: 1.23-3.62 and HR: 2.04, 95% CI: 1.19-3.51, respectively), when the conventional risk factors plus office SBP or 24-hour SBP were accounted for, respectively. Similar but less significant results were obtained with ARVs. A high ARVd or ARVs did not significantly predict cardiovascular mortality in the normotensive subjects.
A high short-term BPV is significantly predictive of long-term cardiovascular mortality in untreated hypertensive but not normotensive community-based subjects, independently of office or 24-hour SBP.
24小时动态血压监测（ABPM）得出的短期血压变异性（BPV）的预后价值仍存在争议。本研究旨在调查社区人群中血压正常者和高血压患者的高BPV的长期预后价值。
从一项社区调查中选取了624名血压正常者和633名未经治疗的台湾高血压参与者（共669名男性，年龄30 - 79岁），他们有基线ABPM数据以及20年全因死亡率和心血管死亡率数据。BPV通过24小时舒张压和收缩压（SBP）的逐次读数平均实际变异性（分别为ARVd和ARVs）进行评估。
在Cox比例风险分析中，ARVd独立于诊室SBP（每1个标准差的风险比（HRs）和95%置信区间（CIs）：分别为1.31（1.10 - 1.55），双变量分析）、24小时SBP（HR：1.19，95% CI：1.00 - 1.43）以及传统危险因素（年龄、性别、吸烟、总胆固醇、高密度脂蛋白胆固醇和空腹血糖，HR：1.40，95% CI：1.18 - 1.67）预测心血管死亡率。在高血压患者中，当分别考虑传统危险因素加诊室SBP或24小时SBP时，高ARVd与低ARVd（中位数：8.8mmHg）相比显著预测心血管死亡率（HR：分别为2.11，95% CI：1.23 - 3.62和HR：2.04，95% CI：1.19 - 3.51）。ARVs也得到了类似但不太显著的结果。高ARVd或ARVs在血压正常者中未显著预测心血管死亡率。
在未经治疗的高血压社区人群而非血压正常者中，高短期BPV显著预测长期心血管死亡率，且独立于诊室或24小时SBP。
