Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
The Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Am J Hypertens. 2017 Nov 6;30(12):1177-1188. doi: 10.1093/ajh/hpx122.
Blood pressure variability ratio (BPVR)(derived from within-subject SD of 24-hour ambulatory blood pressure [BP]) predicts all-cause mortality independent of BP and has a similar prognostic ability to ambulatory arterial stiffness (AASI). Whether BPVR, and AASI, offer prognostic information beyond measurements of arterial stiffness at a given pressure, as indexed by pulse wave velocity (PWV), is not known.
We assessed whether BPVR and AASI were associated with indices of subclinical organ damage (TOD) [estimated glomerular filtration rate (eGFR), left ventricular mass index, early-to-late transmitral velocity (E/A), carotid intima-media thickness (IMT)] independent of BP, and whether BPVR-TOD and AASI-TOD relations were independent of PWV (applanation tonometry) in 772 randomly selected participants from an urban, developing community. AASI was derived from 24-hour diastolic BP vs. systolic BP standard linear regression.
On bivariate analyses, BPVR, AASI, and PWV were correlated with all indices of TOD (P < 0.0005). However, after adjustments for potential confounders including age and 24-hour mean BP, BPVR, and PWV (P < 0.005 to P < 0.0001), but not AASI (P > 0.25), were independently associated with eGFR, but not other indices of TOD. Importantly, the BPVR-eGFR relation was independent of BP variability (P < 0.005) and PWV (P < 0.001).
BPVR was negatively associated with eGFR independent of mean BP, BP variability, and PWV. Therefore, in the prediction of cardiovascular risk, measurements of arterial stiffening (BPVR) may provide information beyond the impact of arterial stiffness.
血压变异性比（BPVR）（源自 24 小时动态血压的个体内标准差）可独立于血压预测全因死亡率，且与动态动脉僵硬度（AASI）具有相似的预后能力。BPVR 和 AASI 是否提供了超越特定压力下动脉僵硬度测量的预后信息，其指标为脉搏波速度（PWV），目前尚不清楚。
我们评估了 BPVR 和 AASI 是否与亚临床器官损伤（TOD）[估算肾小球滤过率（eGFR）、左心室质量指数、早期至晚期二尖瓣血流速度（E/A）、颈动脉内膜中层厚度（IMT）]指数相关，这些指标独立于血压，以及 BPVR-TOD 和 AASI-TOD 关系是否独立于 PWV（平板压力测量法），共纳入了 772 名来自城市发展社区的随机参与者。AASI 是从 24 小时舒张压与收缩压的标准线性回归中得出的。
在双变量分析中，BPVR、AASI 和 PWV 与 TOD 的所有指标均相关（P < 0.0005）。然而，在调整了年龄和 24 小时平均血压等潜在混杂因素后，BPVR 和 PWV（P < 0.005 至 P < 0.0001），但不是 AASI（P > 0.25），与 eGFR 独立相关，但与其他 TOD 指标无关。重要的是，BPVR 与 eGFR 的关系独立于血压变异性（P < 0.005）和 PWV（P < 0.001）。
BPVR 与 eGFR 呈负相关，独立于平均血压、血压变异性和 PWV。因此，在预测心血管风险方面，动脉僵硬度（BPVR）的测量可能提供了超越动脉僵硬度影响的信息。
