Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
University of California, San Francisco, USA.
Ghana Med J. 2023 Jan;57(1):28-36. doi: 10.4314/gmj.v57i1.5.
To identify the determinants of systolic blood pressure variability (SBPV) among Ghanaians.
We undertook a secondary analysis of data collected in a prospective study.
The study involved patients with hypertension and or diabetes receiving care in five hospitals in Ghana.
We assessed determinants of SBPV among 2,785 Ghanaian patients. We calculated the standard deviation (SD) of systolic BP recordings of 3 to 10 visits per patient over 18 months as a measure of SBPV. A multivariate linear regression analysis was fitted to identify factors independently associated with risk visit-to-visit SBP standard deviation.
The mean SD of individual patient visit-to-visit SBP overall was 14.8± 6.3 mm Hg. Those with hypertension and diabetes had the highest SD of 15.4 ±6.2 mm Hg followed by 15.2 ±6.5 mm Hg among those with hypertension only and then 12.0 ± 5.2 mm Hg among those with diabetes only, p<0.0001. Factors independently associated with SBPV with adjusted β coefficients (95% CI) included age: 0.06 (0.03 - 0.08) for each year rise in age, eGFR -0.03 (-0.05 - -0.02) for each ml/min rise, low monthly income of <210 Ghana cedis 1.45 (0.43-2.46), and secondary level of education -1.10 (-1.69, -0.50). Antihypertensive classes were associated with SBPV, the strongest associations being hydralazine 2.35 (0.03 - 4.68) and Methyldopa 3.08 (2.39 - 3.77).
Several socio-demographic and clinical factors are associated with SBPV. Future studies should assess the contribution of SBPV to CVD outcomes among indigenous Africans and identify actionable targets.
Funding for this study was provided by MSD, Novartis, Pfizer, Sanofi (each a Participant Company) and the Bill and Melinda Gates Foundation (collectively, the Funders) through the New Venture Fund (NVF). FSS and BO are also supported by funding from the National Heart, Lung, and Blood Institute (R01HL152188).
确定加纳人群收缩压变异性（SBPV）的决定因素。
我们对一项前瞻性研究中收集的数据进行了二次分析。
该研究涉及在加纳五家医院接受高血压和/或糖尿病治疗的患者。
我们评估了 2785 名加纳患者的 SBPV 决定因素。我们计算了每位患者 3 至 10 次就诊的收缩压记录的标准差（SD），作为 SBPV 的衡量标准，为期 18 个月。进行了多元线性回归分析，以确定与风险就诊间收缩压标准差独立相关的因素。
总体而言，每位患者就诊间 SBP 的个体 SD 平均值为 14.8±6.3mmHg。高血压和糖尿病患者的 SD 最高，为 15.4±6.2mmHg，其次是仅高血压患者为 15.2±6.5mmHg，仅糖尿病患者为 12.0±5.2mmHg，p<0.0001。与 SBPV 相关的独立因素，经调整后的β系数（95%置信区间）包括年龄：年龄每增加 1 岁，增加 0.06（0.03-0.08）；eGFR 每增加 1ml/min，减少 0.03（-0.05- -0.02）；每月收入低于 210 加纳塞地 1.45（0.43-2.46）；以及中学教育程度-1.10（-1.69，-0.50）。抗高血压药物类别与 SBPV 相关，最强的关联是肼屈嗪 2.35（0.03-4.68）和甲基多巴 3.08（2.39-3.77）。
一些社会人口统计学和临床因素与 SBPV 相关。未来的研究应评估就诊间收缩压变异性对非洲土着人群心血管疾病结局的影响，并确定可操作的目标。
本研究由 MSD、诺华、辉瑞、赛诺菲（每家均为参与公司）和比尔和梅林达盖茨基金会（统称为资助者）通过新风险基金（NVF）提供资金。FSS 和 BO 还得到了美国国立心肺血液研究所（R01HL152188）的资助。
