Veloudi Panagiota, Blizzard Christopher L, Head Geoffrey A, Abhayaratna Walter P, Stowasser Michael, Sharman James E
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia;
Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia;
Am J Hypertens. 2016 Sep;29(9):1046-54. doi: 10.1093/ajh/hpw037. Epub 2016 Apr 13.
The average of multiple blood pressure (BP) readings (mean BP) independently predicts target organ damage (TOD). Observational studies have also shown an independent relationship between BP variability (BPV) and TOD, but there is limited longitudinal data. This study aimed to determine the effects of changes in mean BP levels compared with BPV on left ventricular mass index (LVMI) and aortic pulse wave velocity (aPWV).
Mean BP levels (research-protocol clinic BP (clinic BP), 24-hour ambulatory BP, and 7-day home BP) and BPV were assessed in 286 patients with uncomplicated hypertension (mean age 64±8 SD years, 53% women) over 12 months. Reading-to-reading BPV (from 24-hour ambulatory BP) and day-to-day BPV (from 7-day home BP) were assessed at baseline and 12 months, and visit-to-visit BPV (clinic BP) was assessed from 5 visits over 12 months. LVMI was measured by 3D echocardiography and aPWV with applanation tonometry.
The strongest predictors of the changes in LVMI (ΔLVMI) were the changes in mean 24-hour systolic BPs (SBPs) (P < 0.02). Similarly, the strongest predictors of the changes in aPWV (ΔaPWV) were the changes in mean 24-hour ambulatory SBPs (P < 0.01) and the changes in mean clinic SBP (P < 0.001). However, none of the changes in BPV were independently associated with ΔLVMI or ΔaPWV (P > 0.05 for all).
Changes in mean BP levels, but not BPV, were most relevant to changes in TOD in patients with uncomplicated hypertension. Thus, from this point of view, BPV appears to have limited clinical utility in this patient population.
多次血压（BP）读数的平均值（平均血压）可独立预测靶器官损害（TOD）。观察性研究也显示血压变异性（BPV）与TOD之间存在独立关系，但纵向数据有限。本研究旨在确定平均血压水平变化与BPV相比对左心室质量指数（LVMI）和主动脉脉搏波速度（aPWV）的影响。
在286例无并发症高血压患者（平均年龄64±8岁，标准差，53%为女性）中，评估其12个月内的平均血压水平（研究方案诊所血压（诊所血压）、24小时动态血压和7天家庭血压）及BPV。在基线和12个月时评估逐次读数BPV（来自24小时动态血压）和每日BPV（来自7天家庭血压），并在12个月内的5次就诊中评估就诊间BPV（诊所血压）。通过三维超声心动图测量LVMI，采用压平式眼压计测量aPWV。
LVMI变化（ΔLVMI）的最强预测因素是平均24小时收缩压（SBP）的变化（P<0.02）。同样，aPWV变化（ΔaPWV）的最强预测因素是平均24小时动态SBP的变化（P<0.01）和平均诊所SBP的变化（P<0.001）。然而，BPV的变化均与ΔLVMI或ΔaPWV无独立相关性（所有P>0.05）。
在无并发症高血压患者中，平均血压水平的变化而非BPV变化与TOD变化最为相关。因此，从这一角度来看，BPV在该患者群体中的临床应用价值似乎有限。
