Manousopoulos Konstantinos, Koroboki Eleni, Barlas Gerassimos, Lykka Aikaterini, Tsoutsoura Nefeli, Flessa Konstantina, Kanakakis Ioannis, Paraskevaidis Ioannis, Zakopoulos Nikolaos, Manios Efstathios
Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Computer Science & Engineering Department, College of Engineering, American University of Sharjah, Sharjah, United Arab Emirates.
Hypertens Res. 2021 Jan;44(1):55-62. doi: 10.1038/s41440-020-0512-3. Epub 2020 Jul 16.
Increased blood pressure (BP) variability is associated with the development of target organ damage. However, the optimal type and index of BP variability (BPV) regarding their prognostic significance is unclear. The aim of our study was to compare the association of ambulatory and home BPV with the left ventricular mass index (LVMI) in patients with chronic kidney disease (CKD). From a total of 1560 consecutive subjects, 137 hypertensive patients with CKD underwent home and ambulatory BP monitoring and echocardiographic measurements. The variability of home BP monitoring was quantified by using the standard deviation (SD), coefficient of variation (CV), and morning minus evening BP values. Ambulatory BPV was quantified using the SD, CV, and the time rate (TR) of BP variation. The univariate analysis demonstrated that day-to-day systolic SD and the 24-h TR of systolic BP (SBP) variation were significantly associated with the LVMI. The multivariate linear regression analysis showed a significant and independent association of the LVMI with the 24-h TR of SBP variation (B = 9.204, 95% CI: 1.735-16.672; p = 0.016). A 0.1-mmHg/min increase in the 24-h TR of SBP variation was associated with an increment of 9.204 g/m in the LVMI, even after adjustment for BP and other vascular risk factors. In conclusion, ambulatory BPV but not home BPV was associated with the LVMI in CKD patients. The 24-h TR of SBP variation was the only BPV index associated with the LVMI, independent of average BP values.
血压（BP）变异性增加与靶器官损害的发生相关。然而，关于血压变异性（BPV）的最佳类型和指标及其预后意义尚不清楚。我们研究的目的是比较慢性肾脏病（CKD）患者动态血压变异性和家庭血压变异性与左心室质量指数（LVMI）的相关性。在总共1560名连续受试者中，137例CKD高血压患者接受了家庭和动态血压监测以及超声心动图测量。家庭血压监测的变异性通过标准差（SD）、变异系数（CV）以及早晨血压减去晚上血压值来量化。动态血压变异性通过SD、CV以及血压变化的时间率（TR）来量化。单因素分析表明，日间收缩压SD和收缩压（SBP）变化的24小时TR与LVMI显著相关。多因素线性回归分析显示，LVMI与SBP变化的24小时TR存在显著且独立的相关性（B = 9.204，95%CI：1.735 - 16.672；p = 0.016）。即使在调整了血压和其他血管危险因素后，SBP变化的24小时TR每增加0.1 mmHg/min，LVMI就增加9.204 g/m。总之，在CKD患者中，动态血压变异性而非家庭血压变异性与LVMI相关。SBP变化的24小时TR是唯一与LVMI相关的血压变异性指标，独立于平均血压值。
