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Circulation. 2020 Nov 10;142(19):1810-1820. doi: 10.1161/CIRCULATIONAHA.120.049730. Epub 2020 Nov 2.
Ambulatory and home blood pressure (BP) monitoring parameters are better predictors of cardiovascular events than are office BP monitoring parameters, but there is a lack of robust data and little information on heart failure (HF) risk. The JAMP study (Japan Ambulatory Blood Pressure Monitoring Prospective) used the same ambulatory BP monitoring device, measurement schedule, and diary-based approach to data processing across all study centers and determined the association between both nocturnal hypertension and nighttime BP dipping patterns and the occurrence of cardiovascular events, including HF, in patients with hypertension.
This practitioner-based, nationwide, multicenter, prospective, observational study included patients with at least 1 cardiovascular risk factor, mostly hypertension, and free of symptomatic cardiovascular disease at baseline. All patients underwent 24-hour ambulatory BP monitoring at baseline. Patients were followed annually to determine the occurrence of primary end point cardiovascular events (atherosclerotic cardiovascular disease and HF).
A total of 6,359 patients (68.6±11.7 years of age, 48% men) were included in the final analysis. During a mean±SD follow-up of 4.5±2.4 years, there were 306 cardiovascular events (119 stroke, 99 coronary artery disease, 88 HF). Nighttime systolic BP was significantly associated with the risk of atherosclerotic cardiovascular disease and HF (hazard ratio adjusted for demographic and clinical risk factors per 20-mm Hg increase: 1.18 [95% CI, 1.02-1.37], =0.029; and 1.25 [95% CI, 1.00-1.55], =0.048, respectively). Disrupted circadian BP rhythm (riser pattern, nighttime BP higher than daytime BP) was significantly associated with higher overall cardiovascular disease risk (1.48 [95% CI, 1.05-2.08]; =0.024), and especially HF (2.45 [95% CI, 1.34-4.48]; =0.004) compared with normal circadian rhythm.
Nighttime BP levels and a riser pattern were independently associated with the total cardiovascular event rate, in particular for HF. These findings suggest the importance of antihypertensive strategies targeting nighttime systolic BP. Registration: URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000020377.
与诊室血压监测参数相比，动态和家庭血压监测参数更能预测心血管事件，但缺乏有力的数据，对心力衰竭（HF）风险的了解也很少。JAMP 研究（日本动态血压监测前瞻性研究）在所有研究中心使用相同的动态血压监测设备、测量方案和基于日记的方法处理数据，确定了高血压患者夜间高血压和夜间血压下降模式与心血管事件（包括 HF）发生之间的关联。
这项基于医生的、全国性的、多中心的、前瞻性的、观察性研究纳入了至少有 1 个心血管危险因素的患者，主要是高血压，且在基线时无有症状的心血管疾病。所有患者均在基线时接受 24 小时动态血压监测。每年对患者进行随访，以确定主要终点心血管事件（动脉粥样硬化性心血管疾病和 HF）的发生情况。
共有 6359 例患者（68.6±11.7 岁，48%为男性）纳入最终分析。在平均随访 4.5±2.4 年后，发生 306 例心血管事件（119 例卒、99 例冠心病、88 例 HF）。夜间收缩压与动脉粥样硬化性心血管疾病和 HF 的风险显著相关（每增加 20mmHg，调整人口统计学和临床危险因素后的危险比：1.18[95%CI，1.02-1.37]，=0.029；和 1.25[95%CI，1.00-1.55]，=0.048）。昼夜血压节律紊乱（上升型模式，夜间血压高于日间血压）与整体心血管疾病风险增加显著相关（1.48[95%CI，1.05-2.08]；=0.024），尤其是 HF（2.45[95%CI，1.34-4.48]；=0.004），与正常昼夜节律相比。
夜间血压水平和上升型模式与总心血管事件发生率独立相关，特别是 HF。这些发现表明，针对夜间收缩压的降压策略的重要性。
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