Luo Xiaoyang, Liu Wei, Peng Xi, Li Pengqiang
Department of Cardiovascular, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, 100010 Beijing, China.
Department of Cardiovascular, The Second Hospital of Shanxi Medical University, 030000 Taiyuan, Shanxi, China.
Rev Cardiovasc Med. 2024 Nov 8;25(11):397. doi: 10.31083/j.rcm2511397. eCollection 2024 Nov.
Blood pressure variability (BPV) is a critical risk factor for cardiovascular outcomes and is associated with atherosclerotic renal artery stenosis (ARAS), which is diagnosed using digital subtraction angiography (DSA). However, the relationship between the degree of renal artery stenosis (d-RAS), diagnosed using renal artery contrast-enhanced ultrasound (CEUS), and 24-hour ambulatory BPV in hospitalized patients with ARAS remains unclear.
Hospitalized hypertensive patients were divided into ARAS and non-ARAS groups based RAS diagnoses using CEUS. The ARAS patients were further classified into unilateral and bilateral categories. Quantification of BPV over 24 hours, daytime, and nighttime utilized standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). Percentage stenosis was used to evaluate d-RAS. Pearson's and multivariate beta regression analyses were used to assess correlations between BPV and d-RAS.
We found that 24-hour systolic BPV (SBPV), presented as SD, CV, and ARV indices, was positively correlated with unilateral d-RAS (R = 0.460, = 0.001; R = 0.509, < 0.001; R = 0.677, < 0.001, respectively). This correlation was consistent with the daytime SBPV (R = 0.512, < 0.001; R = 0.539, < 0.001; R = 0.678, < 0.001, respectively) and daytime diastolic BPV (DBPV) (R = 0.379, = 0.010; R = 0.397, = 0.007; R = 0.319, = 0.033, respectively). Similarly, 24-hour DBPV assessed by SD and CV also correlated positively with unilateral d-RAS (R = 0.347, = 0.019; R = 0.340, = 0.022, respectively), as did nighttime SBPV assessed by ARV indices (R = 0.415, = 0.005). No significant correlations were found between BPV and bilateral d-RAS ( > 0.05). Multivariate beta regression analysis indicated that 24-hour SBPV (odds ratio [OR] = 1.035, 95% confidence interval [CI]: 1.054-1.607, = 0.035) and daytime SBPV (OR = 1.033, 95% CI: 1.004-1.061, = 0.023; both evaluated via AVR) were independent risk factors for d-RAS.
SBPV is positively correlated with unilateral d-RAS at all time points. Both 24-hour and daytime SBPV (evaluated using ARV indices) were identified as independent d-RAS risk factors.
血压变异性（BPV）是心血管疾病预后的关键危险因素，与动脉粥样硬化性肾动脉狭窄（ARAS）相关，后者通过数字减影血管造影（DSA）进行诊断。然而，使用肾动脉对比增强超声（CEUS）诊断的肾动脉狭窄程度（d-RAS）与住院ARAS患者的24小时动态血压变异性之间的关系仍不明确。
根据使用CEUS进行的RAS诊断，将住院高血压患者分为ARAS组和非ARAS组。ARAS患者进一步分为单侧和双侧两类。利用标准差（SD）、变异系数（CV）和平均实际变异性（ARV）对24小时、日间和夜间的BPV进行量化。狭窄百分比用于评估d-RAS。采用Pearson相关性分析和多元β回归分析评估BPV与d-RAS之间的相关性。
我们发现，以SD、CV和ARV指数表示的24小时收缩压变异性（SBPV）与单侧d-RAS呈正相关（R分别为0.460，P = 0.001；R = 0.509，P < 0.001；R = 0.677，P < 0.001）。这种相关性在日间SBPV（R分别为0.512，P < 0.001；R = 0.539，P < 0.001；R = 0.678，P < 0.001）和日间舒张压变异性（DBPV）中也一致（R分别为0.379，P = 0.010；R = 0.397，P = 0.007；R = 0.319，P = 0.033）。同样，通过SD和CV评估的24小时DBPV也与单侧d-RAS呈正相关（R分别为0.347，P = 0.019；R = 0.340，P = 0.022），通过ARV指数评估的夜间SBPV也是如此（R = 0.415，P = 0.005）。未发现BPV与双侧d-RAS之间存在显著相关性（P > 0.05）。多元β回归分析表明，24小时SBPV（比值比[OR] = 1.035，95%置信区间[CI]：1.054 - 1.607，P = 0.035）和日间SBPV（OR = 1.033，95% CI：1.004 - 1.061，P = 0.023；均通过AVR评估）是d-RAS的独立危险因素。
SBPV在所有时间点均与单侧d-RAS呈正相关。24小时和日间SBPV（使用ARV指数评估）均被确定为d-RAS的独立危险因素。
