Tanner Rikki M, Jaeger Byron C, Bradley Corey K, Thomas S Justin, Min Yuan-I, Hardy Shakia T, Irvin Marguerite Ryan, Shimbo Daichi, Schwartz Joseph E, Muntner Paul
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Am J Hypertens. 2025 Jan 16;38(2):111-119. doi: 10.1093/ajh/hpae133.
The association with cardiovascular disease (CVD) is stronger for mean systolic blood pressure (SBP) estimated using ambulatory blood pressure monitoring (ABPM) vs. office measurements. Determining whether this is due to ABPM providing more measurement reliability or greater ecological validity can inform its use.
We estimated the association of mean SBP based on 2 office measurements and 2, 5, 10, and 20 measurements on ABPM with incident CVD in the Jackson Heart Study (n = 773). Hazard ratios (HRs) for CVD were estimated per standard deviation higher mean SBP. CVD events were defined by incident fatal or non-fatal stroke, non-fatal myocardial infarction, or fatal coronary heart disease.
There were 80 CVD events over a median of 15 years. The adjusted HRs for incident CVD were 1.03 (95% CI: 0.90-1.19) for mean office SBP and 1.30 (95% CI: 1.12-1.50), 1.34 (95% CI: 1.15-1.56), 1.36 (95% CI: 1.17-1.59), and 1.38 (95% CI: 1.17-1.63) for mean SBP using the first 2, 5, 10, and 20 ABPM readings. The difference in the HRs for incident CVD ranged from 0.26 (95% CI: 0.07-0.46) to 0.35 (95% CI: 0.15-0.54) when comparing mean office SBP vs. 2, 5, 10, or 20 sequential ABPM readings. The association with incident CVD was also stronger for mean SBP based on 2, 5, 10, and 20 randomly selected ABPM readings vs. 2 office readings.
Mean SBP based on 2 ABPM readings vs. 2 office measurements had a stronger association with CVD events. The increase in the strength of the association with more ABPM readings was small.
与使用动态血压监测（ABPM）估算的平均收缩压（SBP）相比，诊室测量值与心血管疾病（CVD）的关联更强。确定这是由于ABPM提供了更高的测量可靠性还是更大的生态学效度，可为其应用提供依据。
在杰克逊心脏研究（n = 773）中，我们根据2次诊室测量以及ABPM的2次、5次、10次和20次测量估算平均SBP与CVD发病的关联。每升高一个标准差的平均SBP，估算CVD的风险比（HR）。CVD事件由致死性或非致死性卒中、非致死性心肌梗死或致死性冠心病发病定义。
在中位时间15年期间发生了80例CVD事件。诊室平均SBP发生CVD的校正HR为1.03（95%CI：0.90 - 1.19），而使用ABPM的前2次、5次、10次和20次读数时，平均SBP发生CVD的校正HR分别为1.30（95%CI：1.12 - 1.50）、1.34（95%CI：1.15 - 1.56）、1.36（95%CI：1.17 - 1.59）和1.38（95%CI：1.17 - 1.63）。比较诊室平均SBP与ABPM连续2次、5次、10次或20次读数时，CVD发病HR的差异范围为0.26（95%CI：0.07 - 0.46）至0.35（95%CI：0.15 - 0.54）。基于随机选择的ABPM 2次、5次、10次和20次读数的平均SBP与诊室2次读数相比，与CVD发病的关联也更强。
基于ABPM 2次读数的平均SBP与诊室2次测量相比，与CVD事件的关联更强。随着ABPM读数增加，关联强度的增加幅度较小。
