3rd Department of Internal Medicine, Hypertension-24h Ambulatory Blood Pressure Monitoring Center, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece.
Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, Medical School, Aristotle University of Thessaloniki and 2nd Department of Internal Medicine, Thessaloniki, Greece.
Am J Hypertens. 2018 Oct 15;31(11):1197-1204. doi: 10.1093/ajh/hpy115.
This study compared the diagnostic accuracy of blood pressure (BP) measurement methods, office BP, ambulatory BP monitoring (ABPM), and home BP, in the identification of early vascular aging (EVA) and developed a score to predict the risk of EVA in hypertensive patients.
Two-hundred eighty-two consecutive subjects (39.7% male) aged 56.8 ± 15.8 years were included. Office and out-of-office BP measurements including ABPM on a usual working day and 7 days home BP monitoring were performed. Carotid-femoral pulse wave velocity (c-f PWV) was measured in all patients. EVA was defined as c-f PWV values higher than the expected for age average values according to European population data.
In univariate analysis, EVA was significantly correlated with office systolic BP, average 24-hour systolic and diastolic BP, and average 24-hour and office heart rates. The area under the curve for predicting EVA was 0.624 (95% CI 0.551 to 0.697), 0.559 (95% CI 0.484 to 0.635) and 0.565 (95% CI 0.49 to 0.641), for daytime, home, and office systolic BP, respectively. Ambulatory BP variables, age, sex, body mass index, diabetes mellitus (yes/no), and estimated glomerular filtration rate were used to develop a new score for EVA providing a total accuracy of 0.82, 0.84 sensitivity, and 0.78 specificity.
In conclusion, the new risk score, Early Vascular Aging Ambulatory score, may accurately identify hypertensive patients with EVA using ABPM values and classic cardiovascular risk factors.
本研究比较了血压（BP）测量方法、诊室血压、动态血压监测（ABPM）和家庭血压在识别早期血管老化（EVA）方面的诊断准确性，并开发了一种评分来预测高血压患者发生 EVA 的风险。
共纳入 282 例连续患者（39.7%为男性），年龄 56.8±15.8 岁。所有患者均进行诊室和诊室外血压测量，包括在一个工作日和 7 天家庭血压监测时的 ABPM，以及颈动脉-股动脉脉搏波速度（c-f PWV）测量。EVA 定义为根据欧洲人群数据，c-f PWV 值高于年龄平均预期值。
在单因素分析中，EVA 与诊室收缩压、24 小时平均收缩压和舒张压、24 小时和诊室平均心率显著相关。预测 EVA 的曲线下面积分别为 0.624（95%CI 0.551 至 0.697）、0.559（95%CI 0.484 至 0.635）和 0.565（95%CI 0.49 至 0.641），用于日间、家庭和诊室收缩压。ABPM 变量、年龄、性别、体重指数、糖尿病（有/无）和估计肾小球滤过率被用于开发一种新的 EVA 评分，总准确性为 0.82，敏感性为 0.84，特异性为 0.78。
总之，新的风险评分“EVA 动态血压评分”可以使用 ABPM 值和经典心血管危险因素准确识别高血压患者的 EVA。
