Pierdomenico Sante D, Pierdomenico Anna M, Coccina Francesca, Lapenna Domenico, Porreca Ettore
Dipartimento di Scienze Mediche, Orali e Biotecnologiche, Università "Gabriele d'Annunzio", Chieti-Pescara, Italy.
Centro di Ricerca Clinica, Fondazione Università "Gabriele d'Annunzio", Chieti-Pescara, Italy.
Hypertens Res. 2016 Nov;39(11):805-811. doi: 10.1038/hr.2016.74. Epub 2016 Jun 23.
The independent prognostic significance of circadian blood pressure (BP) changes is unclear. We investigated the association between circadian BP changes and cardiovascular risk among elderly-treated hypertensive patients. The occurrence of a composite end point (that is, stroke, coronary events, heart failure and peripheral revascularization) was evaluated among 1191 elderly-treated hypertensive patients (age range 60-90 years). According to the nighttime change and the morning surge (MS) of systolic BP, subjects were divided into groups of dippers with a normal or high MS (DNMS and DHMS, respectively), non-dippers (ND), reverse dippers (RD) and extreme dippers with a normal or high MS (EDNMS and EDHMS, respectively). During the follow-up (9.1±4.9 years, range 0.4-20 years), 392 events occurred. The event rate was 3.63 per 100 patient-years. After adjustment for various covariates, including 24-h BP, the DHMS (hazard ratio (HR) 1.49, 95% confidence interval (CI) 1.02-2.16, P=0.04), ND (HR 1.71, 95% CI 1.28-2.27, P=0.0001), RD (HR 2.05, 95% CI 1.44-2.93, P=0.0001) and EDHMS (HR 3.40, 95% CI 1.96-5.90, P=0.001) were at higher cardiovascular risk than the DNMS. The population attributable risk was 0.6, 7.1, 7.3 and 1.4% for the DHMS, ND, RD and EDHMS, respectively. In elderly-treated hypertensive patients, circadian BP changes were independently associated with increased cardiovascular risk. At the patient level, the highest risk was observed among the EDHMS, followed by the RD, ND and DHMS. At the population level, the highest risk was observed among the RD, followed by the ND, EDHMS and DHMS.
昼夜血压（BP）变化的独立预后意义尚不清楚。我们调查了老年高血压患者昼夜血压变化与心血管风险之间的关联。在1191例老年高血压患者（年龄范围60 - 90岁）中评估复合终点（即中风、冠状动脉事件、心力衰竭和外周血管重建）的发生情况。根据夜间收缩压变化和早晨血压激增（MS），受试者被分为正常或高MS的杓型血压者（分别为DNMS和DHMS）、非杓型血压者（ND）、反杓型血压者（RD）以及正常或高MS的极端杓型血压者（分别为EDNMS和EDHMS）。在随访期间（9.1±4.9年，范围0.4 - 20年），发生了392起事件。事件发生率为每100患者年3.63起。在对包括24小时血压在内的各种协变量进行调整后，DHMS（风险比（HR）1.49，95%置信区间（CI）1.02 - 2.16，P = 0.04）、ND（HR 1.71，95% CI 1.28 - 2.27，P = 0.0001）、RD（HR 2.05，95% CI 1.44 - 2.93，P = 0.0001）和EDHMS（HR 3.40，95% CI 1.96 - 5.90，P = 0.001）的心血管风险高于DNMS。DHMS、ND、RD和EDHMS的人群归因风险分别为0.6%、7.1%、7.3%和1.4%。在老年高血压患者中，昼夜血压变化与心血管风险增加独立相关。在患者层面，EDHMS的风险最高，其次是RD、ND和DHMS。在人群层面，RD的风险最高，其次是ND、EDHMS和DHMS。
