Yazmonit LTD, Eshtaol.
Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
J Hypertens. 2019 Apr;37(4):765-774. doi: 10.1097/HJH.0000000000001920.
Ambulatory pulse pressure (PP) a well known predictor of mortality, is widely believed to be a marker for arterial stiffness. However stiffness itself is pressure-dependent.
Developing a model-based method for splitting PP into two components expressing the contribution of a pressure-independent stiffness ('elastic', elPP) and the pressure-dependence of stiffness ('stiffening', stPP), and investigating their predictive power for all-cause mortality.
Deriving quantitative expressions for elPP and stPP assuming an exponential pressure-volume relationship in arteries, calculated from ambulatory blood pressure (BP) data and estimate standardized hazard ratios with Cox proportional hazards regression in selected patient groups.
Ambulatory BP records of 1999 consecutive hypertensive patients, of whom 103 died from all causes within 5 years, were analyzed. PP, elPP, stPP and stPP/elPP (PP variables) (mean ± SD) were 60 ± 14, 50 ± 10, 10 ± 8 and 0.20 ± 0.14 mmHg, respectively. elPP and stPP were weakly correlated (r = 0.21). Predictive power was found for patients with heart rate less than 70: mean [95% confidence interval] (P value) hazard ratio of PP, stPP and stPP/elPP (adjusted) were 1.48 [1.13-1.95] (P = 0.005), 1.58 [1.20-2.09] (P = 0.001) and 1.78 [1.25-2.52] (P = 0.001), respectively. The elPP (83% of PP) did not show predictive power. None of the PP variables displayed predictive power for the higher-heart-rate subgroup.
Ambulatory PP components provide a novel and clinically valuable tool bridging between PP and arterial properties. Replacing PP by its components, taken as independent variables, may improve predictive power. The prognostic significance of the PP for all-cause mortality in elderly hypertensive patients with lower heart rates is dominated by its smaller component that quantifies arterial stiffening with pressure.
动态脉压（PP）是死亡率的一个众所周知的预测指标，被广泛认为是动脉僵硬的标志物。然而，僵硬本身是依赖于压力的。
开发一种基于模型的方法，将 PP 分解为两个分量，分别表示压力独立的僵硬（“弹性”，elPP）和僵硬对压力的依赖性（“僵硬”，stPP），并研究它们对全因死亡率的预测能力。
从动态血压（BP）数据中推导出动脉中指数压力-容积关系的定量表达式，计算出 elPP 和 stPP，并在选定的患者组中用 Cox 比例风险回归估计标准化风险比。
对 1999 例连续高血压患者的动态 BP 记录进行了分析，其中 103 例在 5 年内死于各种原因。PP、elPP、stPP 和 stPP/elPP（PP 变量）（平均值±标准差）分别为 60±14、50±10、10±8 和 0.20±0.14mmHg。elPP 和 stPP 之间存在弱相关性（r=0.21）。在心率低于 70 的患者中发现了预测能力：PP、stPP 和 stPP/elPP（调整后）的平均[95%置信区间]（P 值）风险比分别为 1.48[1.13-1.95]（P=0.005）、1.58[1.20-2.09]（P=0.001）和 1.78[1.25-2.52]（P=0.001）。elPP（PP 的 83%）没有显示预测能力。在较高心率亚组中，没有一个 PP 变量显示出预测能力。
动态 PP 分量提供了一种新的、有临床价值的工具，将 PP 和动脉特性联系起来。用其组成部分（视为独立变量）代替 PP，可能会提高预测能力。在心率较低的老年高血压患者中，PP 对全因死亡率的预后意义主要由其较小的组成部分决定，该组成部分量化了动脉僵硬与压力的关系。
