Kumanan Thirunavukarasu, Sujanitha Vathulan, Guruparan Mahesan, Rajeshkannan Nadarajah
Department of Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka.
Department of Cardiology, Teaching Hospital-Jaffna, Jaffna, Sri Lanka.
Int J Hypertens. 2019 Dec 5;2019:6450281. doi: 10.1155/2019/6450281. eCollection 2019.
Visit-to-visit variability (VVV) is a relatively new concept in the hypertensive arena. Data regarding VVV are lacking in our region, and factors associated with VVV are rarely examined in previous studies. This study was conducted among 406 patients attended to the cardiology outpatient department of Teaching Hospital, Jaffna, Sri Lanka, in 2018 to assess the long-term variability of blood pressure (BP) by reviewing last six consecutive BP readings from the records retrospectively. Data regarding sociodemographic variables and behavioural factors such as medication adherence, physical activity, smoking, alcohol consumption, and relevant comorbidities were taken through an interviewer-administered questionnaire. Data were analysed by using SPSS version 25 and VVV of systolic blood pressure (SBP) matrix expressed as mean of SD and association were examined with various factors and VVV of SBP. SBP showed high VVV among the participants as expressed by mean of SD which was 13.06 ± 5.64. When comparing mean SD among the categories of different variables, female sex (=0.023) and comorbidities such as diabetes mellitus (DM) (=0.013), chronic kidney disease (CKD) (=0.007), and risk of developing obstructive sleep apnoea (OSA) (=0.04) showed significant variation. Medication adherence to prescribed hypertensive medication was a major issue even though significant association was not found with high VVV (=0.536). The SD of SBP was then classified into high and low VVV groups by means of a cutoff point at the 50th percentile. Bivariate analysis by using Chi-squared test revealed comorbidities such as DM, CKD, and physical activity (=0.044) were significantly associated with high VVV. Further multivariate regression analysis revealed that comorbidities such as DM and CKD have 1.561 times and 5.999 times more risk to show high variability, respectively. In conclusion, we recommend simple practical measures to achieve sustainable BP control among hypertensive patients with DM and CKD to minimize the VVV and improve their cardiovascular outcome.
就诊间血压变异性（VVV）在高血压领域是一个相对较新的概念。我们地区缺乏关于VVV的数据，并且在以往研究中很少对与VVV相关的因素进行考察。本研究于2018年在斯里兰卡贾夫纳教学医院心内科门诊就诊的406例患者中进行，通过回顾病历中连续6次的血压读数来评估血压（BP）的长期变异性。通过访谈式问卷收集有关社会人口学变量以及行为因素的数据，如服药依从性、身体活动、吸烟、饮酒及相关合并症。使用SPSS 25版软件进行数据分析，以标准差（SD）均值表示收缩压（SBP）的VVV，并考察其与各种因素及SBP的VVV之间的关联。参与者的SBP显示出较高的VVV，以SD均值表示为13.06±5.64。在比较不同变量类别的平均SD时，女性（=0.023）以及糖尿病（DM）（=0.013）、慢性肾脏病（CKD）（=0.007）和阻塞性睡眠呼吸暂停（OSA）发生风险（=0.04）等合并症显示出显著差异。尽管未发现与高VVV有显著关联（=0.536），但对规定的降压药物的服药依从性仍是一个主要问题。然后通过第50百分位数的临界点将SBP的SD分为高VVV组和低VVV组。使用卡方检验进行的双变量分析显示，DM、CKD和身体活动（=0.044）等合并症与高VVV显著相关。进一步的多变量回归分析显示，DM和CKD等合并症出现高变异性的风险分别高出1.561倍和5.999倍。总之，我们建议采取简单实用的措施，在患有DM和CKD的高血压患者中实现可持续的血压控制，以最小化VVV并改善其心血管结局。
