Ogawara Ryo, Misaka Tomofumi, Ohashi Naoto, Ichimura Shohei, Tomita Yusuke, Tani Tetsuya, Anzai Fumiya, Sato Yu, Yokokawa Tetsuro, Sato Akihiko, Shimizu Takeshi, Sato Takamasa, Oikawa Masayoshi, Kobayashi Atsushi, Yoshihisa Akiomi, Takeishi Yasuchika
Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
Department of Community Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
Clin Res Cardiol. 2024 Sep 16. doi: 10.1007/s00392-024-02539-7.
Blood pressure (BP) variability (BPV) is associated with an increased risk of cardiovascular events, independent of absolute BP values. However, the predictive significance of very short-term BPV, occurring within seconds or minutes, in patients with ischemic heart disease (IHD) has yet to be established. This prospective study involved 206 consecutive hospitalized patients with IHD (mean age 67.6 years, 78.2% male) who underwent pulse transit time (PTT)-based continuous BP recording during the night-time. Very short-term BPV was assessed by standard deviation (SD), coefficient of variation (CV), and variation independent of mean (VIM) of PTT-BP. Clinical outcome data were collected. When the patients were categorized into two groups according to the median value of very short-term BPV, Kaplan-Meier analysis revealed that patients with elevated SD, CV, and VIM of systolic and diastolic PTT-BP were associated with lower event-free survival rates from the composite cardiovascular events including cardiac deaths, worsening heart failure cases, nonfatal myocardial infarctions, unplanned revascularizations, and strokes over a median follow-up of 797 days. In a multivariate Cox proportional hazards analysis adjusting for confounding variables, each parameter as a continuous variable was independently associated with adverse events. Incorporating very short-term BPV into basic models had a significant impact on risk reclassification and integrated discrimination for cardiovascular outcomes. In conclusion, the identification of patients with elevated very short-term BPV during the night-time through a PTT-driven approach helps stratify the future risk in IHD patients.
血压（BP）变异性（BPV）与心血管事件风险增加相关，独立于绝对血压值。然而，在数秒或数分钟内发生的极短期BPV在缺血性心脏病（IHD）患者中的预测意义尚未确立。这项前瞻性研究纳入了206例连续住院的IHD患者（平均年龄67.6岁，78.2%为男性），这些患者在夜间接受了基于脉搏波传导时间（PTT）的连续血压记录。通过PTT-BP的标准差（SD）、变异系数（CV）和独立于均值的变异（VIM）来评估极短期BPV。收集临床结局数据。当根据极短期BPV的中位数将患者分为两组时，Kaplan-Meier分析显示，收缩压和舒张压PTT-BP的SD、CV和VIM升高的患者，在中位随访797天期间，与包括心源性死亡、心力衰竭加重病例、非致命性心肌梗死、非计划性血管重建和中风在内的复合心血管事件的无事件生存率较低相关。在对混杂变量进行调整的多变量Cox比例风险分析中，每个作为连续变量的参数均与不良事件独立相关。将极短期BPV纳入基本模型对心血管结局的风险重新分类和综合判别具有显著影响。总之，通过PTT驱动的方法识别夜间极短期BPV升高的患者有助于对IHD患者未来的风险进行分层。
