de la Sierra Alejandro, Sierra Cristina, Murillo Marcos, Aiello Tomasso F, Mateu Aina, Almagro Pedro
Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, 08221 Terrassa, Spain.
Department of Internal Medicine, Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain.
J Clin Med. 2023 Feb 14;12(4):1510. doi: 10.3390/jcm12041510.
There is scarce evidence for the prognostic importance of hemodynamic measures, such as blood pressure (BP), BP variability, and arterial stiffness, in the very elderly population with advanced chronic conditions. We aimed to evaluate the prognostic importance of 24 h BP, BP variability, and arterial stiffness in a cohort of very elderly patients admitted to the hospital due to a decompensated chronic disease. We studied 249 patients older than 80 (66% women; 60% congestive heart failure). Noninvasive 24 h monitoring was used to determine 24 h brachial and central BP, BP and heart rate variabilities, aortic pulse wave velocity, and BP variability ratios during admission. The primary outcome was 1-year mortality. Aortic pulse wave velocity (3.3 times for each SD increase) and BP variability ratio (31% for each SD increase) were associated with 1-year mortality, after adjustments for clinical confounders. Increased systolic BP variability (38% increase for each SD change) and reduced heart rate variability (32% increase for each SD change) also predicted 1-year mortality. In conclusion, increased aortic stiffness and BP and heart rate variabilities predict 1-year mortality in very elderly patients with decompensated chronic conditions. Measurements of such estimates could be useful in the prognostic evaluation of this specific population.
对于患有晚期慢性病的高龄人群，血流动力学指标（如血压（BP）、血压变异性和动脉僵硬度）的预后重要性几乎没有证据。我们旨在评估24小时血压、血压变异性和动脉僵硬度在因慢性病失代偿而入院的高龄患者队列中的预后重要性。我们研究了249名年龄超过80岁的患者（66%为女性；60%患有充血性心力衰竭）。采用无创24小时监测来确定入院期间的24小时肱动脉和中心血压、血压和心率变异性、主动脉脉搏波速度以及血压变异性比值。主要结局是1年死亡率。在对临床混杂因素进行调整后，主动脉脉搏波速度（每增加1个标准差增加3.3倍）和血压变异性比值（每增加1个标准差增加31%）与1年死亡率相关。收缩压变异性增加（每变化1个标准差增加38%）和心率变异性降低（每变化1个标准差增加32%）也可预测1年死亡率。总之，主动脉僵硬度增加以及血压和心率变异性增加可预测患有失代偿慢性病的高龄患者的1年死亡率。测量这些指标可能有助于对这一特定人群进行预后评估。
