Hoshide Satoshi, Tomitani Naoko, Kario Kazuomi
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
Hypertens Res. 2023 Jan;46(1):84-90. doi: 10.1038/s41440-022-01048-2. Epub 2022 Oct 16.
The aim of this study was to determine whether a high daytime maximum blood pressure (BP) assessed by ambulatory BP monitoring (ABPM) constitutes a risk for atherosclerotic cardiovascular disease (ASCVD) events, especially in those with increased arterial stiffness, because BP variability is linked to arterial stiffness. A total of 6294 participants (mean age, 68.6 ± 11.7 years; 78% treated hypertensive patients), who had at least 1 cardiovascular risk factor, were followed for 4.5 years. Daytime maximum BP was calculated as the highest 1-hour moving average of 2 consecutive systolic BP (SBP) readings during the daytime. The ambulatory arterial stiffness index (AASI) was calculated as 1 minus the slope of the linear regression line between SBP and diastolic BP during 24-hour BP. During the follow-up, there were 217 ASCVD events (119 stroke and 98 coronary artery disease [CAD]). In the higher-AASI group (≥0.5783), subjects in the top quartile of daytime maximum SBP (≥179.4 mmHg) had a greater risk of stroke events compared to those in other quartiles (adjusted hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.13-3.15). In the higher-AASI group, participants with 24-hour SBP of 130 mmHg or more and in the top quartile of daytime maximum SBP had an adjusted HR (95%CI) of 2.55 (1.32-4.95) compared to those without. The analysis did not suggest that daytime maximum SBP posed a risk for CAD events and in the lower-AASI group. Daytime maximum SBP did pose a risk of stroke events, especially for those with higher arterial stiffness represented as AASI.
本研究的目的是确定通过动态血压监测（ABPM）评估的日间最高血压（BP）是否构成动脉粥样硬化性心血管疾病（ASCVD）事件的风险，尤其是在动脉僵硬度增加的人群中，因为血压变异性与动脉僵硬度相关。共有6294名参与者（平均年龄68.6±11.7岁；78%为接受治疗的高血压患者），他们至少有1种心血管危险因素，随访时间为4.5年。日间最高血压计算为日间连续2次收缩压（SBP）读数的最高1小时移动平均值。动态动脉僵硬度指数（AASI）计算为24小时血压期间SBP与舒张压之间线性回归线斜率的相反数。随访期间，发生217例ASCVD事件（119例卒中，98例冠状动脉疾病[CAD]）。在较高AASI组（≥0.5783）中，日间最高SBP处于最高四分位数（≥179.4 mmHg）的受试者与其他四分位数的受试者相比，发生卒中事件的风险更高（调整后风险比[HR]，1.89；95%置信区间[CI]，1.13 - 3.15）。在较高AASI组中，24小时SBP为130 mmHg或更高且日间最高SBP处于最高四分位数的参与者与未达到此标准的参与者相比，调整后HR（95%CI）为2.55（1.32 - 4.95）。分析未表明日间最高SBP对CAD事件构成风险，且在较低AASI组中也未发现此关联。日间最高SBP确实构成卒中事件的风险，尤其是对于以AASI表示的动脉僵硬度较高的人群。
