Steinsaltz David, Patten Hamish, Bester Dirk, Rehkopf David
Department of Statistics, University of Oxford, Oxford, United Kingdom.
Department of Statistics, University of Oxford, Oxford, United Kingdom; Information Management, International Federation of the Red Cross Red Crescent Societies (IFRC), Geneva, Switzerland.
Am J Cardiol. 2025 Jan 1;234:71-78. doi: 10.1016/j.amjcard.2024.10.005. Epub 2024 Oct 22.
Until recently, there has been a focus on exploring the influence of average blood pressure (BP) on risk of mortality. We go beyond average BP to also investigate mortality risk with respect to variation in BP over 2 timescales-short-term variation among multiple measures at 1 visit, and medium-term variation among the measures at 2 visits several months apart. We present an application of Bayesian hierarchical modeling to the problem of estimating the effect of BP variability on all-cause and cardiovascular mortality. We use data from the Third National Health and Nutrition Examination Survey linked with up to 27 years of mortality follow-up. We find that medium-term systolic BP variability had a very significant predictive value for all-cause mortality in addition to mortality from cardiovascular disease, cerebrovascular disease and heart-attacks combined, approximately 1/3 as large as the well-established impact of mean systolic BP. Medium-term diastolic variability had an additional, although smaller, predictive effect. Short-term variability, in contrast, had little or no measurable predictive value. The medium-term variability effect persisted when controlling for Framingham Risk Score.
直到最近，人们一直专注于探究平均血压（BP）对死亡风险的影响。我们超越了平均血压，还研究了在两个时间尺度上血压变化的死亡风险——一次就诊时多次测量之间的短期变化，以及相隔数月的两次就诊时测量值之间的中期变化。我们展示了贝叶斯分层模型在估计血压变异性对全因死亡率和心血管死亡率影响问题上的应用。我们使用了来自第三次全国健康与营养检查调查的数据，并与长达27年的死亡率随访数据相链接。我们发现，中期收缩压变异性除了对心血管疾病、脑血管疾病和心脏病合并导致的死亡率外，对全因死亡率也具有非常显著的预测价值，其影响约为既定的平均收缩压影响的三分之一。中期舒张压变异性也有额外的预测作用，尽管较小。相比之下，短期变异性几乎没有或没有可测量的预测价值。在控制弗雷明汉风险评分时，中期变异性的影响依然存在。
