Department of Public Health, Shiga University of Medical Science, Otsu, Japan.
Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
J Hum Hypertens. 2019 Mar;33(3):229-236. doi: 10.1038/s41371-018-0129-z. Epub 2018 Nov 12.
Several studies demonstrated that visit-to-visit variability of blood pressure (BP) predicted future events of total death, stroke and cardiovascular disease. Little is known about factors associated with visit-to-visit BP variability in different countries. We recruited participants aged 40-59 years from four countries (Japan, the People's Republic of China [PRC], the United Kingdom [UK] and the United States [US]). At each study visit, BP was measured twice by trained observers using random zero sphygmomanometers after five minutes resting. We defined visit-to-visit BP variability as variation independent of mean (VIM) by using average systolic BP of 1st and 2nd measurement across four study visits. Data on 4680 men and women were analyzed. Mean ± standard deviation of VIM values among participants in Japan, the PRC, the UK and the US were 5.44 ± 2.88, 6.85 ± 3.49, 5.65 ± 2.81 and 5.84 ± 3.01, respectively; VIM value in the PRC participants was significantly higher. Sensitivity analyses among participants without antihypertensive treatment or past history of cardiovascular disease yielded similar results. Higher VIM value was associated with older age, female gender, lower pulse rate and urinary sodium excretion and use of antihypertensive agents such as angiotensin converting enzyme inhibitors, beta blockers and calcium channel blockers. The difference of visit-to-visit BP variability between PRC and other countries remained significant after adjustment for possible confounding factors. In this large international study across four countries, visit-to-visit BP variability in the PRC was higher than in the other three countries. Reproducibility and mechanisms of these findings remain to be elucidated.
多项研究表明，血压（BP）的随访间变异性可预测全因死亡、卒中和心血管疾病的未来事件。但对于不同国家间与随访间 BP 变异性相关的因素知之甚少。我们从四个国家（日本、中华人民共和国、英国和美国）招募了 40-59 岁的参与者。在每次研究访问中，经过 5 分钟的休息后，经过培训的观察者使用随机零汞血压计测量两次血压。我们通过使用 4 次研究访问中第 1 次和第 2 次测量的平均收缩压，将血压的随访间变异性定义为独立于均值的变异（VIM）。分析了来自 4680 名男性和女性的数据。日本、中华人民共和国、英国和美国参与者的 VIM 值的平均值±标准差分别为 5.44±2.88、6.85±3.49、5.65±2.81 和 5.84±3.01；中华人民共和国参与者的 VIM 值显著更高。在未接受抗高血压治疗或无心血管疾病既往史的参与者中进行的敏感性分析得出了相似的结果。更高的 VIM 值与年龄较大、女性、较低的脉搏率和尿钠排泄以及使用血管紧张素转换酶抑制剂、β受体阻滞剂和钙通道阻滞剂等抗高血压药物有关。在调整可能的混杂因素后，中华人民共和国与其他国家之间的随访间 BP 变异性差异仍然显著。在这项跨越四个国家的大型国际研究中，中华人民共和国的随访间 BP 变异性高于其他三个国家。这些发现的可重复性和机制仍有待阐明。
