Department of Primary Care Medicine, University Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia.
Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia.
BMJ Open. 2019 Apr 20;9(4):e025322. doi: 10.1136/bmjopen-2018-025322.
To determine the reproducibility of visit-to-visit blood pressure variability (BPV) in clinical practice. We also determined the minimum number of blood pressure (BP) measurements needed to estimate long-term visit-to-visit BPV for predicting 10-year cardiovascular (CV) risk.
Retrospective study SETTING: A primary care clinic in a university hospital in Malaysia.
Random sampling of 1403 patients aged 30 years and above without any CV event at baseline.
The effect of the number of BP measurement for calculation of long-term visit-to-visit BPV in predicting 10-year CV risk. CV events were defined as fatal and non-fatal coronary heart disease, fatal and non-fatal stroke, heart failure and peripheral vascular disease.
The mean 10-year SD of systolic blood pressure (SBP) for this cohort was 13.8±3.5 mm Hg. The intraclass correlation coefficient (ICC) for the SD of SBP based on the first eight and second eight measurements was 0.38 (p<0.001). In a primary care setting, visit-to-visit BPV (SD of SBP calculated from 20 BP measurements) was significantly associated with CV events (adjusted OR 1.07, 95% CI 1.02 to 1.13, p=0.009). Using SD of SBP from 20 measurement as reference, SD of SBP from 6 measurements (median time 1.75 years) has high reliability (ICC 0.74, p<0.001), with a mean difference of 0.6 mm Hg. Hence, a minimum of six BP measurements is needed for reliably estimating intraindividual BPV for CV outcome prediction.
Long-term visit-to-visit BPV is reproducible in clinical practice. We suggest a minimum of six BP measurements for calculation of intraindividual visit-to-visit BPV. The number and duration of BP readings to derive BPV should be taken into consideration in predicting long-term CV risk.
确定临床实践中血压变异性（BPV）的可重复性。我们还确定了估计长期随访 BPV 以预测 10 年心血管（CV）风险所需的最低血压（BP）测量次数。
回顾性研究
马来西亚一所大学医院的初级保健诊所。
随机抽取 1403 名年龄在 30 岁及以上且基线时无任何 CV 事件的患者。
用于计算长期随访 BPV 以预测 10 年 CV 风险的 BP 测量次数的效果。CV 事件定义为致命和非致命性冠心病、致命和非致命性中风、心力衰竭和外周血管疾病。
该队列的收缩压（SBP）10 年标准差平均值为 13.8±3.5 mm Hg。基于前 8 次和后 8 次测量的 SBP 标准差的组内相关系数（ICC）为 0.38（p<0.001）。在初级保健环境中，随访 BPV（根据 20 次 BP 测量计算的 SBP 标准差）与 CV 事件显著相关（调整后的 OR 为 1.07，95%CI 为 1.02 至 1.13，p=0.009）。以 SBP 的标准差来自 20 次测量作为参考，来自 6 次测量（中位数时间 1.75 年）的 SBP 标准差具有很高的可靠性（ICC 为 0.74，p<0.001），平均差异为 0.6 mm Hg。因此，需要至少 6 次 BP 测量才能可靠地估计 CV 结局预测的个体内 BPV。
临床实践中可重复长期随访 BPV。我们建议至少进行六次 BP 测量以计算个体内随访 BPV。在预测长期 CV 风险时，应考虑 BPV 的读数次数和持续时间。
