Saladini Francesca, Fania Claudio, Mos Lucio, Vriz Olga, Mazzer Andrea, Spinella Paolo, Garavelli Guido, Ermolao Andrea, Rattazzi Marcello, Palatini Paolo
Department of Medicine, University of Padova, Padova, Italy.
Department of Cardiology, Cittadella Town Hospital, Padova, Italy.
Am J Hypertens. 2020 Nov 3;33(11):1030-1037. doi: 10.1093/ajh/hpaa121.
Whether blood pressure variability (BPV) measured with ambulatory monitoring (short-term BPV) or computed from office visits (long-term BPV) are related to each other and carry similar prognostic information is not well known. We investigated the independent determinants of short-term and long-term BPVs and their predictive capacity for the development of major adverse cardiovascular and renal events (MACEs) in a cohort of young hypertensive participants.
Long-term BPV was calculated as visit-to-visit SD and average real variability from office blood pressure (BP) measured during 7 visits, within 1 year. Short-term BPV was calculated as weighted 24-hour SD and coefficient of variation. Hazard ratios (HRs) for risk of MACE were computed from multivariable Cox regressions.
1,167 participants were examined; mean age was 33.1 ± 8.5 years. Variables independently associated with 24-hour systolic SD were 24-hour systolic BP, low physical activity, smoking, baseline office pulse pressure, systolic BP dipping, and diastolic white coat effect, while those associated with long-term BPV were mean systolic BP, age, female gender, and baseline office heart rate. During a median follow-up of 17.4 years 75 MACEs occurred. In Cox analysis only short-term BPV resulted a significant predictor of MACE (HR, 1.31 (1.07-1.59); P = 0.0086), while no index of long-term BPV was independently associated with outcome.
In young hypertensive subjects only short-term BPV resulted a significant predictor of MACE on top of traditional ambulatory BP monitoring parameters. Whether reduction of short-term BPV with therapy may reduce the cardiovascular risk independently from the effects on 24-hour BP is a matter for future research.
通过动态血压监测测量的血压变异性（短期血压变异性）或根据门诊就诊数据计算得出的血压变异性（长期血压变异性）是否相互关联以及是否携带相似的预后信息，目前尚不清楚。我们在一组年轻高血压参与者中研究了短期和长期血压变异性的独立决定因素及其对主要不良心血管和肾脏事件（MACE）发生的预测能力。
长期血压变异性计算为1年内7次就诊时测量的诊室血压（BP）的就诊间标准差和平均实际变异性。短期血压变异性计算为加权24小时标准差和变异系数。MACE风险的风险比（HR）通过多变量Cox回归计算。
共检查了1167名参与者；平均年龄为33.1±8.5岁。与24小时收缩压标准差独立相关的变量有24小时收缩压、低体力活动、吸烟、基线诊室脉压、收缩压谷峰差和舒张期白大衣效应，而与长期血压变异性相关的变量有平均收缩压、年龄、女性性别和基线诊室心率。在中位随访17.4年期间，发生了75例MACE。在Cox分析中，只有短期血压变异性是MACE的显著预测因素（HR，1.31（1.07 - 1.59）；P = 0.0086），而长期血压变异性的指标均与结局无独立关联。
在年轻高血压患者中，仅短期血压变异性是传统动态血压监测参数之外MACE的显著预测因素。通过治疗降低短期血压变异性是否能独立于对24小时血压的影响而降低心血管风险，是未来研究的课题。
