Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA.
Neurol Neurochir Pol. 2023;57(5):423-429. doi: 10.5603/pjnns.94839. Epub 2023 Sep 1.
Long-term variability in systolic blood pressure (SBP) is associated with a higher risk of cardiovascular events. Little is known about any association between within-visit SBP variability, stroke, coronary heart disease (CHD), and cardiovascular (CV) death.
Participants included adults ≥ 18 years who participated in the US National Health and Nutrition Examination Surveys from 1999 to 2012 linked to the national death index in 2012. Stroke was self-reported. SBP was obtained up to four times by a physician, using a manual sphygmomanometer according to standard procedures. Within-visit SBP variability was defined as the standard deviation of the BP measurements, stratified into quartiles. We evaluated the relationship between within-visit SBP variability and the odds of stroke or CHD using multivariable logistic regression, and with CV mortality, using multivariable Cox regression.
Of the 27,987 adults, 16.4% were aged ≥ 65 years, 51.3% were female, 71.2% were white, and 10.7% were black. Factors associated with higher mean SBP variability included older age, hypertension, chronic kidney disease, peripheral artery disease, and smoking (all p < 0.05). The prevalence of stroke significantly increased across SBP variability quartiles, from 2.1% for quartile 1 to 3.7% for quartile 4 (p < 0.001). High SBP variability was associated with higher odds of stroke [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.4-2.2], coronary heart disease (OR 2.0, 95% CI 1.6-2.4), and increased risk of CV mortality [hazard ratio (HR) 2.7, 95% CI 2.3-3.1]. The relationships were not observed after adjusting for covariables.
Within-visit variability in SBP is associated with increased risks of stroke, coronary heart disease, and cardiovascular mortality, but the relationship is confounded by age and covariates.
收缩压（SBP）的长期变化与心血管事件风险的增加有关。关于就诊内 SBP 变异性与中风、冠心病（CHD）和心血管（CV）死亡之间的任何关联，知之甚少。
参与者包括 1999 年至 2012 年期间参加美国国家健康和营养检查调查的年龄≥18 岁的成年人，并于 2012 年与国家死亡指数相关联。中风为自我报告。SBP 由医生使用手动血压计根据标准程序测量多达四次，就诊内 SBP 变异性定义为 BP 测量值的标准差，分层为四分位数。我们使用多变量逻辑回归评估就诊内 SBP 变异性与中风或 CHD 发生几率之间的关系，并使用多变量 Cox 回归评估与 CV 死亡率的关系。
在 27987 名成年人中，16.4%年龄≥65 岁，51.3%为女性，71.2%为白人，10.7%为黑人。与较高平均 SBP 变异性相关的因素包括年龄较大、高血压、慢性肾脏病、外周动脉疾病和吸烟（均 p<0.05）。中风的患病率随着 SBP 变异性四分位数的增加而显著增加，从四分位数 1 的 2.1%增加到四分位数 4 的 3.7%（p<0.001）。高 SBP 变异性与中风的发生几率增加相关[比值比（OR）1.8，95%置信区间（CI）1.4-2.2]、冠心病（OR 2.0，95%CI 1.6-2.4）和心血管死亡率增加的风险[风险比（HR）2.7，95%CI 2.3-3.1]。调整协变量后，这些关系并不明显。
就诊内 SBP 变异性与中风、冠心病和心血管死亡率的风险增加相关，但这种关系受到年龄和协变量的混杂。
