Department of Family Medicine and Primary Health Care, Kowloon East Cluster, Hospital Authority, Hong Kong, China.
J Clin Hypertens (Greenwich). 2021 Jul;23(7):1291-1299. doi: 10.1111/jch.14304. Epub 2021 Jun 16.
Meta-analyses showed that non-dipping of nocturnal blood pressure on ambulatory blood pressure monitoring (ABPM) was associated with adverse cardiovascular prognosis. However, these prognostic studies were mainly conducted in Caucasian and Japanese populations. Whether this association applies to Chinese patients remained uninvestigated. A total of 1199 Chinese patients with hypertension undergoing ABPM between January 2012 and December 2014 were recruited retrospectively from five public hypertension referral clinics in Hong Kong. Patients were followed up for a mean 6.42 years for cardiovascular morbidity and mortality and all-cause mortality. Time to event of different dipping patterns was compared by Kaplan-Meier curves. Hazard ratios (HR) were obtained by Cox proportional hazard models with patient demographics and confounding factors adjusted in multivariate regression. A total of 163 end point events occurred in the period. Normal dipping was observed in 446 patients (37.2%), non-dipping in 490 (40.9%), reverse dipping in 161 (13.4%), and extreme dipping in 102 (8.5%). Kaplan-Meier analyses showed inferior survival in non-dippers and reverse dippers for total cardiovascular events and coronary events but not cerebrovascular events. After adjusting for confounding factors, Cox regressions showed HRs 1.166 (CI 0.770-1.764) and 1.173 (CI 0.681-2.021) in non-dippers and reverse dippers for total cardiovascular events, and HRs 1.320 (CI 0.814-2.141) and 1.476 (CI 0.783-2.784) for coronary events. Nocturnal blood pressure non-dipping, and to a greater extent reverse dipping, demonstrated adverse cardiovascular prognosis in a cohort of Chinese patients with hypertension in Hong Kong. Further focused studies on cerebrovascular events and reverse dippers were warranted to refine risk stratification.
荟萃分析表明，动态血压监测（ABPM）中的夜间血压非杓型与不良心血管预后相关。然而，这些预后研究主要在白种人和日本人群中进行。这种相关性是否适用于中国患者仍未得到研究。本研究回顾性纳入了 2012 年 1 月至 2014 年 12 月在香港 5 家公共高血压转诊诊所接受 ABPM 的 1199 例中国高血压患者。中位随访 6.42 年，以评估心血管发病率和死亡率及全因死亡率。Kaplan-Meier 曲线比较不同杓型患者的时间事件。多变量回归校正患者人口统计学和混杂因素后，通过 Cox 比例风险模型获得风险比（HR）。在此期间共发生 163 例终点事件。446 例（37.2%）患者为杓型，490 例（40.9%）为非杓型，161 例（13.4%）为反杓型，102 例（8.5%）为深杓型。Kaplan-Meier 分析显示，非杓型和反杓型患者的总心血管事件和冠状动脉事件生存率较差，但脑血管事件无差异。校正混杂因素后，Cox 回归分析显示非杓型和反杓型患者的总心血管事件 HR 分别为 1.166（CI 0.770-1.764）和 1.173（CI 0.681-2.021），冠状动脉事件 HR 分别为 1.320（CI 0.814-2.141）和 1.476（CI 0.783-2.784）。香港高血压中国患者中，夜间血压非杓型，更明显的是反杓型，与不良心血管预后相关。需要进一步的针对脑血管事件和反杓型的重点研究，以完善风险分层。
