Wang Ji-Guang, Zhou Duo, Jeffers Barrett W
Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, Department of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Pfizer Inc, New York City, NY, USA.
J Am Soc Hypertens. 2017 Jul;11(7):402-411. doi: 10.1016/j.jash.2017.05.006. Epub 2017 May 29.
We conducted a post hoc analysis of blood pressure (BP) data from long-term antihypertensive trials to identify predictors of visit-to-visit BP variability (BPV). BPV was defined as the within-subject coefficient of variation in systolic BP from week 12 onward. BP data from the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, Comparison of Amlodipine Versus Enalapril to Limit Occurrences of Thrombosis, NY92011, and R-0510 trials were pooled and dichotomized into top 25th and bottom 75th percentiles because of positive skew. Significant (P < .001) predictors of BPV within the top 25th percentile were identified using logistic regression. The baseline characteristics of the pooled cohort (n = 47,558) were similar between patients who received amlodipine (n = 17,499) versus other antihypertensive drugs (n = 29,491). BPV in the top 25th percentile was lower with amlodipine versus other treatments (13.7 ± 3.2 vs. 14.3 ± 3.5), with single-study analyses of Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, and Comparison of Amlodipine Versus Enalapril to Limit Occurrences of Thrombosis all showing BPV was the lowest with amlodipine. Baseline diastolic BP, estimated glomerular filtration rate, and smoking were predictors of BPV, with significant two-way interactions between smoking and both age and body mass index and between systolic BP or diastolic BP and being randomized to treatment other than amlodipine. In conclusion, analysis of BPV required transformation of BP data. After transformation, a number of baseline variables and combinations of variables were predictors of BPV.
我们对长期降压试验中的血压（BP）数据进行了事后分析，以确定就诊间血压变异性（BPV）的预测因素。BPV定义为从第12周起收缩压的受试者内变异系数。合并了盎格鲁-斯堪的纳维亚心脏结局试验-降压组、预防心脏病发作的降压和降脂治疗试验、氨氯地平与依那普利预防血栓形成发生率的比较试验、NY92011试验和R-0510试验的BP数据，并由于正偏态将其分为前25%和后75%。使用逻辑回归确定前25%内BPV的显著（P <.001）预测因素。接受氨氯地平治疗的患者（n = 17,499）与接受其他降压药物治疗的患者（n = 29,491）相比，合并队列（n = 47,558）的基线特征相似。与其他治疗相比，氨氯地平治疗组前25%的BPV较低（13.7±3.2 vs. 14.3±3.5），对盎格鲁-斯堪的纳维亚心脏结局试验-降压组、预防心脏病发作的降压和降脂治疗试验以及氨氯地平与依那普利预防血栓形成发生率的比较试验的单研究分析均显示氨氯地平的BPV最低。基线舒张压、估计肾小球滤过率和吸烟是BPV的预测因素，吸烟与年龄和体重指数之间以及收缩压或舒张压与随机接受氨氯地平以外治疗之间存在显著的双向相互作用。总之，BPV分析需要对BP数据进行转换。转换后，一些基线变量和变量组合是BPV的预测因素。
