Perkiömäki Juha S, Nortamo Santeri, Ylitalo Antti, Kesäniemi Antero, Ukkola Olavi, Huikuri Heikki V
Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
Am J Hypertens. 2017 Mar 1;30(3):264-270. doi: 10.1093/ajh/hpw149.
We hypothesized that elevated nighttime systolic ambulatory blood pressure (ABP) yields additional information compared with daytime systolic ABP for the long-term risk of atrial fibrillation (AF) and perhaps should be taken into account in treatment strategies for preventing the increasing burden of AF during aging.
A total of 903 subjects with or without hypertension aged 40 to 59 years, who were recruited to the Oulu Project Elucidating Risk of Atherosclerosis (OPERA) study, underwent ABP monitoring, thorough clinical examinations and laboratory tests.
After an average of 16.4 ± 3.6 years of follow-up, 91 (10%) of the study subjects had experienced a new-onset AF requiring a hospital emergency room or hospital visit. Of the components of baseline ABP, the nighttime mean systolic blood pressure had the strongest univariable association with the occurrence of AF (120.8 ± 15.9 vs. 116.4 ± 14.1 mm Hg, P = 0.006, in subjects with vs. without the occurrence AF). When the univariable predictors of AF, such as age, sex, body mass index, height, smoking history, alanine aminotransferase, uric acid, and fasting plasma glucose, were entered in the multivariable Cox hazards model, age (P < 0.001), and body mass index (P = 0.014) retained their significant predictive power. After adjustments in this clinical hazards model, the nighttime mean systolic blood pressure still predicted the occurrence of AF (hazards ratio = 1.07 per every 5 mm Hg increase, 95% confidence intervals = 1.004-1.15, P = 0.038).
Of the baseline ABP characteristics, the nighttime systolic blood pressure is a significant independent contributor to the long-term risk of new-onset AF requiring a hospital visit.
我们假设，与白天收缩期动态血压相比，夜间收缩期动态血压升高可为心房颤动（AF）的长期风险提供更多信息，并且在预防老龄化过程中AF负担增加的治疗策略中或许应予以考虑。
共有903名年龄在40至59岁之间、患有或未患有高血压的受试者被纳入奥卢动脉粥样硬化风险研究（OPERA），接受了动态血压监测、全面的临床检查和实验室检测。
平均随访16.4±3.6年后，91名（10%）研究对象发生了需要前往医院急诊室或就诊的新发AF。在基线动态血压的各项指标中，夜间平均收缩压与AF发生的单变量关联最强（发生AF的受试者为120.8±15.9 mmHg，未发生AF的受试者为116.4±14.1 mmHg，P = 0.006）。当将AF的单变量预测因素，如年龄、性别、体重指数、身高、吸烟史、丙氨酸转氨酶、尿酸和空腹血糖，纳入多变量Cox风险模型时，年龄（P < 0.001）和体重指数（P = 0.014）仍保留其显著的预测能力。在此临床风险模型进行调整后，夜间平均收缩压仍可预测AF的发生（每升高5 mmHg，风险比=1.07，95%置信区间=1.004 - 1.15，P = 0.038）。
在基线动态血压特征中，夜间收缩压是需要前往医院就诊的新发AF长期风险的重要独立影响因素。
