Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Department of Medicine, Shenzhen Hong Kong University Hospital, Shenzhen, China.
Cardiovasc Diabetol. 2021 Apr 24;20(1):88. doi: 10.1186/s12933-021-01280-z.
High blood pressure is a major risk factor for cardiovascular disease. Visit-to-visit blood pressure variability (BPV) has recently been shown to predict cardiovascular outcomes. We investigated the predictive value of BPV for major adverse cardiovascular events (MACE) among patients with coronary artery disease (CAD), with and without type 2 diabetes mellitus (T2DM).
Patients with stable CAD were enrolled and monitored for new MACE. Visit-to-visit BPV was defined as the coefficient of variation (CV) of systolic and diastolic BP across clinic visits. Multivariable logistic regression analysis was performed to evaluate the association of BPV with MACE. Area under the receiver operating characteristic curve (AUC) was used to assess its predictive ability.
Among 1140 Chinese patients with stable CAD, 192 (17%) experienced a new MACE. In multivariable analyses, the risk of MACE was significantly associated with CV of systolic BP (odds ratio [OR] for highest versus lowest quartile, 3.30; 95% CI 1.97-5.54), and diastolic BP (OR for highest versus lowest quartile, 2.39; 95% CI 1.39-4.11), after adjustment for variables of the risk factor model (age, gender, T2DM, hypertension, antihypertensive agents, number of BP measurements) and mean BP. The risk factor model had an AUC of 0.70 for prediction of MACE. Adding systolic/diastolic CV into the risk factor model with mean BP significantly increased the AUC to 0.73/0.72 (P = 0.002/0.007). In subgroup analyses, higher CV of systolic BP remained significantly associated with an increased risk for MACE in patients with and without T2DM, whereas the association of CV of diastolic BP with MACE was observed only in those without T2DM.
Visit-to-visit variability of systolic BP and of diastolic BP was an independent predictor of new MACE and provided incremental prognostic value beyond mean BP and conventional risk factors in patients with stable CAD. The association of BPV in CAD patients without T2DM with subsequent risk for MACE was stronger than in those with T2DM.
高血压是心血管疾病的主要危险因素。最近研究表明，血压变异性（BPV）可预测心血管结局。本研究旨在探讨血压变异性对合并或不合并 2 型糖尿病（T2DM）的稳定性冠心病（CAD）患者发生主要不良心血管事件（MACE）的预测价值。
入选稳定性 CAD 患者，监测新发生的 MACE。血压变异性定义为诊室血压的收缩压和舒张压变异系数（CV）。采用多变量逻辑回归分析评估 BPV 与 MACE 的相关性。采用受试者工作特征曲线下面积（AUC）评估其预测能力。
1140 例中国稳定性 CAD 患者中，192 例（17%）发生新发生的 MACE。多变量分析显示，与最低四分位相比，收缩压 CV 最高四分位的 MACE 风险比（OR）为 3.30（95%CI：1.975.54），舒张压 CV 最高四分位的 MACE 风险比为 2.39（95%CI：1.394.11），校正危险因素模型（年龄、性别、T2DM、高血压、降压药、血压测量次数）和平均血压后。危险因素模型预测 MACE 的 AUC 为 0.70。在危险因素模型中加入收缩压/舒张压 CV 后，AUC 显著增加至 0.73/0.72（P=0.002/0.007）。亚组分析显示，在合并或不合并 T2DM 的患者中，较高的收缩压 CV 仍与 MACE 风险增加显著相关，而舒张压 CV 与 MACE 的相关性仅见于不合并 T2DM 的患者。
收缩压和舒张压的 BPV 是稳定性 CAD 患者新发 MACE 的独立预测因素，其提供了平均血压和传统危险因素之外的额外预后价值。在不合并 T2DM 的 CAD 患者中，BPV 与随后发生 MACE 的相关性强于合并 T2DM 的患者。
