Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
Genki Plaza Medical Center for Health Care, Tokyo, Japan.
Am J Hypertens. 2020 May 21;33(6):520-527. doi: 10.1093/ajh/hpz197.
We examined our hypothesis that participants with higher mean nighttime blood pressure (BP) levels and/or those with a riser BP pattern, both measured by ambulatory blood pressure (BP) monitoring (ABPM), would show higher risk for cardiovascular disease (CVD) events compared to those with normal nighttime BP levels or a normal dipper BP pattern of circadian BP rhythm, even in very elderly participants in a general practice population.
This prospective observational study enrolled 485 very elderly outpatients of ≥80 years (mean age: 83.2 ± 3.3 years; 44.7% male; 89.3% using antihypertensive medications). The prevalences of extreme dipper, dipper, nondipper, and riser status were 15.5%, 38.6%, 32.2%, and 13.8%, respectively.
During a mean follow-up of 3.9 years (1,734 person-years), 41 CVD events occurred. The participants with a riser pattern (higher nighttime systolic BP [SBP] than daytime SBP) showed a significantly higher risk for CVD events with adjustment for covariates: hazard ratio (HR), 2.61; 95% confidence interval (CI), 1.03-6.62. Even after adjusting for covariates and mean nighttime SBP level, the CVD risks in participants with a riser pattern remained significant: HR, 3.11; 95% CI, 1.10-8.88. On the other hand, all BP variables showed no significant risks for CVD events. In addition, when we divided study participants into quartiles by their ambulatory BP levels, none of the ambulatory BP variables showed a J- or U-shaped relationship with CVD event risk.
In very elderly general practice outpatients, a riser BP pattern was significantly associated with CVD events independently of mean nighttime BP.
我们检验了我们的假设，即通过动态血压监测（ABPM）测量的夜间平均血压（BP）水平较高和/或具有升型 BP 模式的参与者，与夜间 BP 水平正常或正常昼夜 BP 节律的夜间 BP 模式的参与者相比，心血管疾病（CVD）事件的风险更高，即使在一般实践人群中非常高龄的参与者中也是如此。
这项前瞻性观察研究纳入了 485 名≥80 岁的高龄门诊患者（平均年龄：83.2±3.3 岁；44.7%为男性；89.3%服用抗高血压药物）。极端杓型、杓型、非杓型和升型的患病率分别为 15.5%、38.6%、32.2%和 13.8%。
在平均 3.9 年（1734 人年）的随访期间，发生了 41 例 CVD 事件。与白天 SBP 相比，夜间 SBP 升高的升型模式参与者的 CVD 事件风险显著升高，调整协变量后 HR 为 2.61；95%CI 为 1.03-6.62。即使在调整协变量和夜间 SBP 水平后，升型模式参与者的 CVD 风险仍然显著：HR 为 3.11；95%CI 为 1.10-8.88。另一方面，所有 BP 变量均与 CVD 事件风险无显著相关性。此外，当我们根据 ABPM 水平将研究参与者分为 quartiles 时，ABPM 变量均未显示与 CVD 事件风险呈 J 形或 U 形关系。
在非常高龄的普通门诊患者中，升型 BP 模式与 CVD 事件显著相关，与夜间平均 BP 无关。
