Department of Medicine, Columbia University, New York, New York Department of Biostatistics Department of Epidemiology Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama Familial Hypercholesterolemia Foundation, Pasadena, California Department of Preventive Medicine Department of Medicine, Northwestern University, Chicago, Illinois Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA.
J Hypertens. 2020 Jan;38(1):102-110. doi: 10.1097/HJH.0000000000002221.
To evaluate the associations of high awake blood pressure (BP), high asleep BP, and nondipping BP, determined by ambulatory BP monitoring (ABPM), with left ventricular hypertrophy (LVH) and geometry.
Black and white participants (n = 687) in the Coronary Artery Risk Development in Young Adults study underwent 24-h ABPM and echocardiography at the Year 30 Exam in 2015-2016. The prevalence and prevalence ratios of LVH were calculated for high awake SBP (≥130 mmHg), high asleep SBP (≥110 mmHg), the cross-classification of high awake and asleep SBP, and nondipping SBP (percentage decline in awake-to-asleep SBP < 10%). Odds ratios for abnormal left ventricular geometry associated with these phenotypes were calculated.
Overall, 46.0 and 49.1% of study participants had high awake and asleep SBP, respectively, and 31.1% had nondipping SBP. After adjustment for demographics and clinical characteristics, high awake SBP was associated with a prevalence ratio for LVH of 2.79 [95% confidence interval (95% CI) 1.63-4.79]. High asleep SBP was also associated with a prevalence ratio for LVH of 2.19 (95% CI 1.25-3.83). There was no evidence of an association between nondipping SBP and LVH (prevalence ratio 0.70, 95% CI 0.44-1.12). High awake SBP with or without high asleep SBP was associated with a higher odds ratio of concentric remodeling and hypertrophy.
Awake and asleep SBP, but not the decline in awake-to-asleep SBP, were associated with increased prevalence of cardiac end-organ damage.
通过动态血压监测（ABPM）评估清醒时血压升高、睡眠时血压升高和非杓型血压与左心室肥厚（LVH）和几何结构的关系。
在 2015-2016 年的第 30 年检查中，冠状动脉风险发展中的黑人及白人参与者（n=687）接受了 24 小时 ABPM 和超声心动图检查。计算了高清醒 SBP（≥130mmHg）、高睡眠 SBP（≥110mmHg）、清醒和睡眠 SBP 的交叉分类以及非杓型 SBP（清醒到睡眠 SBP 的下降百分比<10%）的 LVH 患病率和患病率比。计算了与这些表型相关的异常左心室几何结构的比值比。
总体而言，分别有 46.0%和 49.1%的研究参与者存在高清醒和睡眠 SBP，31.1%存在非杓型 SBP。在调整人口统计学和临床特征后，高清醒 SBP 与 LVH 的患病率比为 2.79（95%置信区间 95%CI 1.63-4.79）。高睡眠 SBP 也与 LVH 的患病率比为 2.19（95%CI 1.25-3.83）相关。非杓型 SBP 与 LVH 之间没有关联（患病率比 0.70，95%CI 0.44-1.12）。高清醒 SBP 伴或不伴高睡眠 SBP 与同心重构和肥厚的更高比值比相关。
清醒时和睡眠时的 SBP，而不是清醒到睡眠时 SBP 的下降，与心脏终末器官损害的发生率增加相关。
