Omboni Stefano, Alfie Jose, Arystan Ayana, Avolio Alberto, Barin Edward, Bokusheva Jamilya, Bulanova Natalia, Butlin Mark, Cuffaro Paula, Derevyanchenko Maria, Grigoricheva Elena, Gurevich Alexandra, Konradi Alexandra, Muiesan Maria Lorenza, Paini Anna, Pereira Telmo, Statsenko Mikhail E, Tan Isabella
Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy.
Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation.
J Hypertens. 2024 Sep 1;42(9):1590-1597. doi: 10.1097/HJH.0000000000003763. Epub 2024 May 15.
In hemodialysis patients, central hemodynamics, stiffness, and wave reflections assessed through ambulatory blood pressure monitoring (ABPM) showed superior prognostic value for cardiovascular (CV) events than peripheral blood pressures (BPs). No such evidence is available for lower-risk hypertensive patients.
In 591 hypertensive patients (mean age 58 ± 14 years, 49% males), ambulatory brachial and central BP, pulse wave velocity (PWV), and augmentation index (AIx) were obtained with a validated upper arm cuff-based pulse wave analysis technology. Information on treatment for hypertension (73% of patients), dyslipidemia (27%), diabetes (8%), CV disease history (25%), was collected. Patients were censored for CV events or all-cause death over 4.2 years.
One hundred and four events (24 fatal) were recorded. Advanced age [hazard ratio and 95% confidence interval: 1.03 (1.01, 1.05), P = 0.0001], female sex [1.57 (1.05, 2.33), P = 0.027], CV disease [2.22 (1.50, 3.29), P = 0.0001], increased 24-h central pulse pressure (PP) [1.56 (1.05, 2.31), P = 0.027], PWV [1.59 (1.07, 2.36), P = 0.022], or AIx [1.59 (1.08, 2.36), P = 0.020] were significantly associated with a worse prognosis (univariate Cox regression analysis). The prognostic power of peripheral and central BPs was lower. However, PWV [1.02 (0.64, 1.63), P = 0.924], AIx [1.06 (0.66, 1.69), P = 0.823], and central PP [1.18 (0.76, 1.82), P = 0.471], were not significant predictors in multivariate analyses.
In hypertensive patients, ambulatory central PP, PWV, and AIx are associated with an increased risk of CV morbidity and all-cause mortality. However, this association is not independent of other patient characteristics.
在血液透析患者中，通过动态血压监测（ABPM）评估的中心血流动力学、血管僵硬度和波反射对心血管（CV）事件的预后价值优于外周血压（BP）。对于低风险高血压患者，尚无此类证据。
在591例高血压患者（平均年龄58±14岁，49%为男性）中，采用经过验证的基于上臂袖带的脉搏波分析技术获取动态肱动脉血压和中心血压、脉搏波速度（PWV）和增强指数（AIx）。收集了有关高血压治疗（73%的患者）、血脂异常（27%）、糖尿病（8%）、心血管疾病史（25%）的信息。对患者进行4.2年的心血管事件或全因死亡审查。
记录了104起事件（24起致命）。高龄[风险比和95%置信区间：1.03（1.01，1.05），P = 0.0001]、女性[1.57（1.05，2.33），P = 0.027]、心血管疾病[2.22（1.50，3.29），P = 0.0001]、24小时中心脉压（PP）升高[1.56（1.05，2.31），P = 0.027]、PWV[1.59（1.07，2.36），P = 0.022]或AIx[1.59（1.08，2.36），P = 0.020]与较差的预后显著相关（单变量Cox回归分析）。外周血压和中心血压的预后能力较低。然而，在多变量分析中，PWV[1.02（0.64，1.63），P = 0.924]、AIx[1.06（0.66，1.69），P = 0.823]和中心PP[1.18（0.76，1.82），P = 0.471]不是显著的预测因素。
在高血压患者中，动态中心PP、PWV和AIx与心血管疾病发病率和全因死亡率风险增加相关。然而，这种关联并非独立于其他患者特征。
