From the Department of Endocrinology, Odense University Hospital, Denmark (T.B.O., J.V.S., M.K.B., M.P.); Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Denmark (S.R.); Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Denmark (J.K.K.V.-N.); Department of Internal Medicine, Holbæk Hospital, Denmark (M.P., M.H.O.); and Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, Denmark (M.P., M.H.O.).
Hypertension. 2017 Nov;70(5):1034-1041. doi: 10.1161/HYPERTENSIONAHA.117.09173. Epub 2017 Sep 11.
Markers of target-organ damage and 24-hour ambulatory blood pressure (BP) measurement improve cardiovascular risk stratification. The prevalence of target-organ damage and raised BP increases with aging. The study aim was to evaluate the impact of age and target-organ damage on the prognostic value of ambulatory BP. Markers of target-organ damage and ambulatory BP were measured in 1408 healthy people aged 41 or 51 (middle-aged group), and 61 or 71 (older group) years. The primary outcome was cardiovascular events after 16 years of follow-up, with data obtained from national registries. The prognostic value of BP was evaluated with Cox regression models, adjusted for traditional risk factors and target-organ damage, including left ventricular mass, pulse wave velocity, carotid plaques, and urine albumin/creatinine ratio. A total of 323 events were observed. In comparison with traditional risk factors, adding systolic BP and presence of target-organ damage improved risk stratification by increasing concordance index from 0.711 to 0.728 (=0.01). In middle-aged subjects with target-organ damage, increment in pulse pressure (hazard ratio, 1.70; 95% confidence interval, 1.31-2.21; <0.01) and increment in average real variability (hazard ratio, 1.29; 95% confidence interval, 1.05-1.59; =0.02) were associated with a greater risk of cardiovascular disease compared with subjects without target-organ damage: hazard ratio, 1.04 (95% confidence interval, 0.74-1.46; =0.81); for interaction, 0.02; and hazard ratio, 0.89 (95% confidence interval, 0.69-1.14; =0.36); for interaction, 0.01. Target-organ damage may be a marker of individual susceptibility to the harmful effects of pulse pressure and BP variability on the cardiovascular system in middle-aged individuals.
目标器官损伤标志物和 24 小时动态血压（BP）测量可改善心血管风险分层。目标器官损伤和血压升高的患病率随着年龄的增长而增加。本研究旨在评估年龄和目标器官损伤对动态血压预后价值的影响。在 1408 名年龄为 41 或 51 岁（中年组）和 61 或 71 岁（老年组）的健康人群中测量了目标器官损伤和动态血压的标志物。主要结局是 16 年随访后的心血管事件，数据来自国家登记处。使用 Cox 回归模型评估 BP 的预后价值，该模型调整了传统危险因素和目标器官损伤，包括左心室质量、脉搏波速度、颈动脉斑块和尿白蛋白/肌酐比值。共观察到 323 例事件。与传统危险因素相比，添加收缩压和存在目标器官损伤可通过将一致性指数从 0.711 提高到 0.728（=0.01）来改善风险分层。在中年有目标器官损伤的患者中，脉压升高（危险比，1.70；95%置信区间，1.31-2.21；<0.01）和平均真实变异性升高（危险比，1.29；95%置信区间，1.05-1.59；=0.02）与无目标器官损伤的患者相比，心血管疾病风险更高：危险比，1.04（95%置信区间，0.74-1.46；=0.81）；交互检验，0.02；危险比，0.89（95%置信区间，0.69-1.14；=0.36）；交互检验，0.01。目标器官损伤可能是个体对脉压和 BP 变异性对中年人心血管系统有害影响易感性的标志物。
