Wing Lindon M H, Chowdhury Enayet K, Reid Christopher M, Beilin Lawrence J, Brown Mark A
School of Medicine, Flinders University, Adelaide, South Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria.
Blood Press Monit. 2018 Oct;23(5):237-243. doi: 10.1097/MBP.0000000000000331.
Numerous studies have shown a stronger relationship between ambulatory blood pressure (ABP), particularly night ABP, and cardiovascular events/mortality than for office blood pressure (OBP). A previous clinical trial (Syst-Eur) showed that pretreatment ABP was only a better predictor of outcome than OBP in placebo-treated participants. The current study in treated elderly hypertensives from the Second Australian National Blood Pressure study (ANBP2) examined whether pretreatment ABP was a better predictor of mortality than OBP over long-term (∼11 years) follow-up.
ANBP2 was a comparative outcome trial in 6083 off-treatment or previously untreated elderly hypertensives. In the ABP substudy, at study entry, participants had ABP and nurse-performed OBP measurements. Cox proportional hazards analysis assessed the relationships between both OBP and ABP at study entry and 11-year all-cause and cardiovascular mortality, with results pooled from both active treatment phases.
In 702 participants, over a median of 10.8 years, including 6.7 years after the trial, 167 died (82 cardiovascular). Pretreatment 'night' systolic ABP and pulse pressure were the best predictors of '11-year' cardiovascular mortality (hazard ratios: 1.26; 95% confidence intervals: 1.10-1.45, P=0.001 and 1.18; 1.06-1.31, P=0.003, respectively) and all-cause mortality (hazard ratios: 1.15; 95% confidence intervals:1.05-1.28, P=0.005 and 1.09; 1.10-1.31, P=0.03, respectively). OBP was not a significant predictor of mortality.
In actively treated elderly hypertensives participating in ANBP2, all-cause or cardiovascular deaths were significantly related to pretreatment ABP, particularly to night-time systolic ABP and pulse pressure, but not to OBP.
大量研究表明，动态血压（ABP），尤其是夜间ABP，与心血管事件/死亡率之间的关系比诊室血压（OBP）更为密切。此前一项临床试验（Syst-Eur）显示，在接受安慰剂治疗的参与者中，治疗前ABP对预后的预测效果仅优于OBP。当前这项针对澳大利亚第二次全国血压研究（ANBP2）中接受治疗的老年高血压患者的研究，探讨了在长达约11年的随访期内，治疗前ABP对死亡率的预测是否优于OBP。
ANBP2是一项针对6083名未接受治疗或此前未接受过治疗的老年高血压患者的比较性结局试验。在ABP子研究中，研究开始时，参与者接受了ABP测量以及护士测量的OBP。Cox比例风险分析评估了研究开始时OBP和ABP与11年全因死亡率和心血管死亡率之间的关系，结果汇总自两个积极治疗阶段。
在702名参与者中，中位随访时间为10.8年，包括试验结束后的6.7年，167人死亡（82人死于心血管疾病）。治疗前“夜间”收缩压ABP和脉压是“11年”心血管死亡率（风险比：1.26；95%置信区间：1.10 - 1.45，P = 0.001；以及1.18；1.06 - 1.31，P = 0.003）和全因死亡率（风险比：1.15；95%置信区间：1.05 - 1.28，P = 0.005；以及1.09；1.01 - 1.31，P = 0.03）的最佳预测指标。OBP并非死亡率的显著预测指标。
在参与ANBP2的接受积极治疗的老年高血压患者中，全因死亡或心血管死亡与治疗前ABP显著相关，尤其是与夜间收缩压ABP和脉压相关，但与OBP无关。
