Division of General Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.
Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada.
PLoS One. 2021 Apr 2;16(4):e0248362. doi: 10.1371/journal.pone.0248362. eCollection 2021.
Although high visit-to-visit blood pressure variability (BPV) is an independent risk factor for cardiovascular events, the frequency of high BPV is unknown. We conducted this study to define the frequency of high BPV in primary care patients, clinical correlates, and association with antihypertensive therapies.
Retrospective cohort study using electronic medical record data (with previously validated case definitions based on billing codes, free text analysis of progress notes, and prescribing data) from the Canadian Primary Care Sentinel Surveillance Network of 221,803 adults with multiple clinic visits over a 2-year period. We a priori defined a standard deviation>13.0 mm Hg in visit-to-visit systolic blood pressure (SBP) as "high BPV" based on prior literature.
Overall, 85,455 (38.5%) patients had hypertension (mean 6.56 visits with SBP measurement, mean SBP 134.4 with Standard Deviation [SD] 11.3, 33.2% exhibited high BPV) and 136,348 did not (mean 3.96 visits with SBP measurement, mean SBP 120.9 with SD 8.2, 16.5% had high BPV). BPV increased with age regardless of whether individuals had hypertension or not; at all ages BPV varied across antihypertensive treatment regimens and was greater in those receiving renin angiotensin blockers or beta-blockers (p<0.001). High BPV was more frequent in patients with diabetes, chronic kidney disease, dementia, depression, chronic obstructive pulmonary disease, or Parkinson's disease.
High visit-to-visit BPV is present in one sixth of non-hypertensive adults and one third of hypertensive individuals and is more common in those with comorbidities. The frequency of high BPV varies across antihypertensive treatment regimens.
尽管血压变异性（BPV）高是心血管事件的独立危险因素，但高 BPV 的频率尚不清楚。我们进行这项研究旨在确定初级保健患者中高 BPV 的频率、临床相关性及其与抗高血压治疗的关系。
使用加拿大初级保健监测网络的电子病历数据（基于计费代码、门诊记录的自由文本分析和处方数据的先前验证的病例定义）进行回顾性队列研究，该网络包括 221,803 名在 2 年内多次就诊的成年人。我们根据先前的文献，将收缩压（SBP）的随访间标准差>13.0mmHg 预先定义为“高 BPV”。
总体而言，85,455 名（38.5%）患者患有高血压（平均就诊 6.56 次，SBP 测量值为 134.4mmHg，标准差为 11.3mmHg，33.2%存在高 BPV），136,348 名患者未患有高血压（平均就诊 3.96 次，SBP 测量值为 120.9mmHg，标准差为 8.2mmHg，16.5%存在高 BPV）。无论患者是否患有高血压，BPV 均随年龄增长而增加；在所有年龄段，BPV 均因抗高血压治疗方案而异，且在使用肾素血管紧张素阻滞剂或β受体阻滞剂的患者中更大（p<0.001）。高 BPV 在患有糖尿病、慢性肾脏病、痴呆、抑郁症、慢性阻塞性肺疾病或帕金森病的患者中更为常见。
非高血压成年患者中有六分之一和高血压患者中有三分之一存在高 BPV，且在合并症患者中更为常见。高 BPV 的频率因抗高血压治疗方案而异。
