Wolfson Centre for Prevention of Stroke and Dementia, Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK.
Int J Stroke. 2021 Aug;16(6):683-691. doi: 10.1177/1747493020971905. Epub 2020 Nov 9.
Beat-to-beat blood pressure variability is associated with increased stroke risk but its importance at different ages is unclear.
To determine the age-sex distribution of blood pressure variability in patients with transient ischemic stroke or minor stroke.
In consecutive patients within six weeks of transient ischemic stroke or non-disabling stroke (Oxford Vascular Study), non-invasive blood pressure was measured beat-to-beat over five minutes (Finometer). The age-sex distribution of blood pressure variability (residual coefficient of variation) was determined for systolic blood pressure and diastolic blood pressure. The risk of top-decile blood pressure variability was estimated (logistic regression), unadjusted, and adjusted for age, sex, and cardiovascular risk factors.
In 908 of 1013 patients, excluding 54 in atrial fibrillation and 51 with low quality recordings, residual coefficient of variation was positively skewed with a median systolic residual coefficient of variation of 4.2% (IQR 3.2-5.5) and diastolic residual coefficient of variation of 3.9% (3.0-5.5), with 90th centile thresholds of 7.2 and 7.3%. Median systolic residual coefficient of variation was higher in patients under 50 years (4.5 and 3.0-5.3) compared to 60-70 years (4.1 and 3.2-5.2), but rose to 4.5% (3.5-6.9) above 80 years, with an increasingly positive skew. The proportion of patients with markedly elevated blood pressure variability in the top-decile increased significantly per decade (OR 1.72, p < 0.001), after adjustment for sex and risk factors.
Median beat-to-beat blood pressure variability fell in midlife, reflecting loss of physiological, organized blood pressure variability. However, rates of markedly elevated blood pressure variability significantly increased with greater age, suggesting that blood pressure variability may be particularly important in older patients.
逐搏血压变异性与中风风险增加相关，但在不同年龄阶段的重要性尚不清楚。
确定短暂性脑缺血发作或小卒中患者的血压变异性的年龄性别分布。
在短暂性脑缺血发作或非致残性卒中（牛津血管研究）后 6 周内的连续患者中，使用非侵入性血压计（Finometer）在 5 分钟内逐搏测量血压。确定收缩压和舒张压的血压变异性（剩余变异系数）的年龄性别分布。在未调整和调整年龄、性别和心血管危险因素后，估计最高十分位数血压变异性的风险（逻辑回归）。
在 1013 例患者中的 908 例中，排除 54 例心房颤动患者和 51 例记录质量低的患者，剩余变异系数呈正偏态分布，收缩压剩余变异系数中位数为 4.2%（IQR 3.2-5.5），舒张压剩余变异系数中位数为 3.9%（3.0-5.5），第 90 百分位阈值分别为 7.2%和 7.3%。50 岁以下患者的收缩压剩余变异系数中位数较高（4.5%和 3.0-5.3），而 60-70 岁患者的收缩压剩余变异系数中位数为 4.1%（3.2-5.2），但在 80 岁以上升至 4.5%（3.5-6.9），呈正偏态分布。在调整性别和危险因素后，最高十分位数中血压变异显著升高的患者比例随年龄每增加 10 岁显著增加（OR 1.72，p<0.001）。
中年时逐搏血压变异性下降，反映了生理性、有组织的血压变异性的丧失。然而，随着年龄的增长，血压变异性显著增加的比率显著增加，这表明血压变异性在老年患者中可能尤为重要。
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