Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia.
Commonwealth Scientific and Industrial Research Organisation (CSIRO), Perth, WA, Australia.
J Clin Hypertens (Greenwich). 2021 Jan;23(1):44-52. doi: 10.1111/jch.14114. Epub 2020 Dec 3.
Night-time blood pressure (BP) is an important predictor of cardiovascular outcomes. Its assessment, however, remains challenging due to limited accessibility to ambulatory BP devices in many settings, costs, and other factors. We hypothesized that BP measured in a supine position during daytime may perform similarly to night-time BP when modeling their association with vascular hypertension-mediated organ damage (HMOD). Data from 165 hypertensive patients were used who as part of their routine clinic workup had a series of standardized BP measurements including seated attended office, seated and supine unattended office, and ambulatory BP monitoring. HMOD was determined by assessment of kidney function and pulse wave velocity. Correlation analysis was carried out, and univariate and multivariate models were fitted to assess the extent of shared variance between the BP modalities and their individual and shared contribution to HMOD variables. Of all standard non-24-hour systolic BP assessments, supine systolic BP shared the highest degree of variance with systolic night-time BP. In univariate analysis, both systolic supine and night-time BP were strong determinants of HMOD variables. In multivariate models, supine BP outperformed night-time BP as the most significant determinant of HMOD. These findings indicate that supine BP may not only be a clinically useful surrogate for night-time BP when ambulatory BP monitoring is not available, but also highlights the possibility that unattended supine BP may be more closely related to HMOD than other BP measurement modalities, a proposition that requires further investigations in prospective studies.
夜间血压（BP）是心血管结局的重要预测指标。然而，由于在许多情况下，动态血压设备的可及性有限、成本以及其他因素，其评估仍然具有挑战性。我们假设，在白天仰卧位测量的 BP 在模拟其与血管性高血压介导的器官损害（HMOD）的相关性时，其表现可能与夜间 BP 相似。该研究使用了 165 名高血压患者的数据，这些患者作为其常规临床检查的一部分，进行了一系列标准化的 BP 测量，包括坐姿有监护的诊室、坐姿无监护的诊室和动态血压监测。HMOD 通过肾功能和脉搏波速度评估来确定。进行了相关分析，并拟合了单变量和多变量模型，以评估 BP 模式之间的共享方差程度及其对 HMOD 变量的个体和共同贡献。在所有标准的非 24 小时收缩压评估中，仰卧位收缩压与夜间收缩压共享的方差最大。在单变量分析中，仰卧位收缩压和夜间收缩压都是 HMOD 变量的重要决定因素。在多变量模型中，仰卧位 BP 优于夜间 BP，是 HMOD 的最显著决定因素。这些发现表明，当无法进行动态血压监测时，仰卧位 BP 不仅可以作为夜间 BP 的临床有用替代指标，而且还突出表明，与其他 BP 测量模式相比，无人值守的仰卧位 BP 可能与 HMOD 更为密切相关，这一观点需要在前瞻性研究中进一步调查。
