Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Clin Hypertens (Greenwich). 2021 Feb;23(2):281-288. doi: 10.1111/jch.14108. Epub 2020 Nov 21.
Blood pressure (BP) is characterized by spontaneous oscillation over time, which is described as BP variability (BPV). The current study aimed to investigate whether short-term BPV was correlated with hypertensive nephropathy in Han Chinese individuals with hypertension. A single-center prospective cohort study of 300 Han Chinese participants with hypertension was conducted in Taiwan. Five different BPV parameters were derived from ambulatory BP monitoring (ABPM), including standard deviation (SD), weighted SD (wSD), coefficient of variation (CoV), successive variation (SV), and average real variability (ARV). Renal event was defined as > 50% reduction in baseline estimated glomerular filtration rate (eGFR). The average age of the participants was 63.5 years. The baseline eGFR was 84.5 mL/min/1.73 m . The participants were divided into two groups according to the wSD of systolic BP (SBP). Survival was assessed via a Kaplan-Meier analysis. During the 4.2-year follow-up, the participants with the highest SBP wSD tertile had a greater number of renal events (6.0%) than their counterparts (0.5%) (log-rank test, p = .007). The Cox proportional hazard regression model was used to assess the independent effects of BPV, and results showed that 24-h SBP (HR = 1.105; 95% CI = 1.020-1.197, p = .015) and 24-h DBP (HR = 1.162; 95% CI = 1.004-1.344, p = .044) were independently associated with renal events. However, BPV parameters were only associated with renal events univariately, but not after adjusting for baseline characteristics, 24-h mean BP, and office BP. Therefore, the risk of hypertensive nephropathy was independently associated with 24-h mean BP, but not with ambulatory BPV, in Han Chinese participants with hypertension.
血压（BP）具有随时间自发波动的特征，这种波动被描述为血压变异性（BPV）。本研究旨在探讨汉族高血压患者的短期 BPV 是否与高血压性肾病相关。在台湾，进行了一项针对 300 名汉族高血压患者的单中心前瞻性队列研究。从动态血压监测（ABPM）中得出了 5 个不同的 BPV 参数，包括标准差（SD）、加权 SD（wSD）、变异系数（CoV）、连续变异（SV）和平均真实变异（ARV）。肾脏事件定义为基础估计肾小球滤过率（eGFR）降低>50%。参与者的平均年龄为 63.5 岁，基础 eGFR 为 84.5mL/min/1.73m 。根据收缩压（SBP）的 wSD 将参与者分为两组。通过 Kaplan-Meier 分析评估生存情况。在 4.2 年的随访期间，SBP wSD 最高三分位组的参与者发生肾脏事件的比例（6.0%）明显高于对照组（0.5%）（对数秩检验，p=0.007）。采用 Cox 比例风险回归模型评估 BPV 的独立影响，结果显示 24 小时 SBP（HR=1.105；95%CI=1.020-1.197，p=0.015）和 24 小时 DBP（HR=1.162；95%CI=1.004-1.344，p=0.044）与肾脏事件独立相关。然而，BPV 参数仅与肾脏事件存在单因素相关，而与基础特征、24 小时平均 BP 和诊室 BP 无关。因此，在汉族高血压患者中，高血压性肾病的风险与 24 小时平均 BP 独立相关，而与动态 BPV 无关。
