From the Policlinico di Monza (G.M.), University Milano-Bicocca, Milan, Italy.
Clinica Medica, Department of Medicine and Surgery (R.F., G.S., C.C., G.G.), University Milano-Bicocca, Milan, Italy.
Hypertension. 2021 Feb;77(2):640-649. doi: 10.1161/HYPERTENSIONAHA.120.16303. Epub 2021 Jan 4.
Home and 24-hour blood pressure (BP and BP) are believed to improve the prognostic value of office BP (BP) alone, but the evidence has limitations such as that (1) these 3 BPs are characterized by multicollinearity and (2) the procedures adopted do not allow quantification of the prognostic advantage. One thousand eight hundred thirty-three individuals belonging to the PAMELA (Pressioni Arteriose Monitorate e Loro Associazioni) were followed for 16 years. Prediction of cardiovascular and all-cause mortality was determined via the goodness of fit of individual data (Cox model), the area underlying the receiving operator curves and the net reclassification improvement of cardiovascular and all-cause mortality risk. Calculations were made for BP alone and after addition of BP, BP, or both, limited to their residual portion which was found to be unexplained by, and thus independent on, BP. With all methods addition of residual out-of-office systolic or diastolic BP to BP significantly improved cardiovascular and all-cause mortality prediction. The improvement was more consistent when BP rather than BP was added to BP and, compared with BP plus BP, no better prediction was found when addition was extended to BP. With all additions, however, the improvement was quantitatively modest, which was the case also when data were separately analyzed in younger and older individuals or in dippers and nondippers. Thus, addition of out-of-office to BP improves prediction of cardiovascular risk, even when data analysis avoids previous limitations. The improvement appears to be limited, however, which raises the question of the advantage to recommend their extended use in clinical practice.
家庭和 24 小时血压（BP 和 BP）被认为可以提高仅办公室 BP（BP）的预后价值，但证据存在局限性，例如：（1）这 3 种 BP 具有多重共线性；（2）所采用的程序不允许量化预后优势。1833 名属于 PAMELA（Pressioni Arteriose Monitorate e Loro Associazioni）的个体被随访了 16 年。通过个体数据的拟合优度（Cox 模型）、接收者操作曲线下的面积和心血管和全因死亡率风险的净重新分类改善来确定心血管和全因死亡率的预测。分别对 BP 进行了计算，然后在加入 BP、BP 或两者的残差部分后进行了计算，发现这些残差部分不能用 BP 解释，因此独立于 BP。使用所有方法，将残余的非诊室收缩压或舒张压添加到 BP 中，均可显著改善心血管和全因死亡率的预测。当添加到 BP 中的是 BP 而不是 BP 时，改善更为一致，与添加 BP 和 BP 相比，当添加扩展到 BP 时，并未发现更好的预测。然而，所有添加都导致了适度的改善，当分别在年轻和年老个体或杓型和非杓型个体中分析数据时，情况也是如此。因此，将非诊室血压加入到 BP 中可以提高心血管风险的预测，即使数据分析避免了先前的局限性。然而，这种改善似乎是有限的，这就提出了一个问题，即是否有必要建议在临床实践中广泛使用它们。
