Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Eur Heart J. 2018 Jun 21;39(24):2243-2251. doi: 10.1093/eurheartj/ehx760.
Blood pressure variability is associated with increased risk of cardiovascular events, particularly in high-risk patients. We assessed if variability was associated with increased risk of cardiovascular events and death in hypertensive patients at different risk levels.
The Valsartan Antihypertensive Long-term Use Evaluation trial was a randomized controlled trial of valsartan vs. amlodipine in patients with hypertension and different risks of cardiovascular events, followed for a mean of 4.2 years. We calculated standard deviation (SD) of mean systolic blood pressure from visits from 6 months onward in patients with ≥3 visits and no events during the first 6 months. We compared the risk of cardiovascular events in the highest and lowest quintile of visit-to-visit blood pressure variability, using Cox regression. For analysis of death, variability was analysed as a continuous variable. Of 13 803 patients included, 1557 (11.3%) had a cardiovascular event and 1089 (7.9%) died. Patients in the highest quintile of SD had an increased risk of cardiovascular events [hazard ratio (HR) 2.1, 95% confidence interval (95% CI) 1.7-2.4; P < 0.0001], and a 5 mmHg increase in SD of systolic blood pressure was associated with a 10% increase in the risk of death (HR 1.10, 95% CI 1.04-1.17; P = 0.002). Associations were stronger among younger patients and patients with lower systolic blood pressure, and similar between patients with different baseline risks, except for higher risk of death among patients with established cardiovascular disease.
Higher visit-to-visit systolic blood pressure variability is associated with increased risk of cardiovascular events in patients with hypertension, irrespective of baseline risk of cardiovascular events. Associations were stronger in younger patients and in those with lower mean systolic blood pressure.
血压变异性与心血管事件风险增加相关，尤其是在高危患者中。我们评估了血压变异性是否与不同心血管风险水平的高血压患者心血管事件和死亡风险增加相关。
缬沙坦抗高血压长期疗效评估试验是一项缬沙坦与氨氯地平治疗高血压和不同心血管事件风险患者的随机对照试验，平均随访 4.2 年。我们计算了≥3 次就诊且前 6 个月无事件的患者从就诊开始后 6 个月的平均收缩压就诊间标准差（SD）。我们使用 Cox 回归比较了就诊间血压变异性最高和最低五分位组的心血管事件风险。对于死亡分析，将变异性作为连续变量进行分析。在纳入的 13803 例患者中，1557 例（11.3%）发生了心血管事件，1089 例（7.9%）死亡。SD 最高五分位组的患者心血管事件风险增加[风险比（HR）2.1，95%置信区间（95%CI）1.7-2.4；P<0.0001]，收缩压 SD 增加 5mmHg 与死亡风险增加 10%相关（HR 1.10，95%CI 1.04-1.17；P=0.002）。这些关联在年轻患者和收缩压较低的患者中更强，在不同基线心血管风险的患者中相似，但在已确诊心血管疾病的患者中死亡风险更高。
高血压患者的就诊间收缩压变异性较高与心血管事件风险增加相关，无论其心血管事件的基线风险如何。这些关联在年轻患者和收缩压较低的患者中更强。
