经皮冠状动脉介入治疗患者的收缩压目标值及变异性与长期临床结局的关联

Association of systolic blood pressure target and variability with long-term clinical outcomes in patients undergoing percutaneous coronary intervention.

作者信息

Kim Byung Sik, Lim Young-Hyo, Shin Jinho, Shin Jeong-Hun

机构信息

Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea.

Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea.

出版信息

Clin Hypertens. 2025 Apr 1;31:e13. doi: 10.5646/ch.2025.31.e13. eCollection 2025.

DOI:10.5646/ch.2025.31.e13

PMID:40201318

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11975637/

Abstract

BACKGROUND

The combined impact of achieving target systolic blood pressure (SBP) and blood pressure variability (BPV) on long-term clinical outcomes in patients with coronary artery disease following percutaneous coronary intervention (PCI) remains unclear. This study aimed to investigate the combined effect of SBP target achievement and BPV on the risk of cardiovascular events in patients undergoing PCI.

METHODS

Consecutive patients who underwent PCI between 2012 and 2016 were included. Patients were classified into four groups based on average follow-up SBP (< 130 or ≥ 130 mmHg) and BPV (categorized as low or high, using the median of the standard deviation of SBP during follow-up). The primary outcome was net adverse clinical events (NACE; defined as all-cause death, nonfatal myocardial infarction, nonfatal stroke, any revascularization, or major bleeding) for up to 5 years.

RESULTS

Among 2,845 patients, 787 (27.7%) experienced NACE during a median follow-up of 5.43 years. Patients with high BPV had a significantly increased risk of long-term clinical outcomes, regardless of whether the target SBP was achieved. Additionally, patients with SBP ≥ 130 mmHg and high BPV had a significantly higher risk of 5-year major adverse cardiac and cerebrovascular events (adjusted hazard ratio [HR], 1.342; 95% confidence interval [CI], 1.067-1.688; = 0.012) and NACE (adjusted HR, 1.262; 95% CI, 1.036-1.537; = 0.021) than those with SBP < 130 mmHg and low BPV.

CONCLUSIONS

The combined impact of SBP target achievement and BPV was significantly associated with the risk of long-term adverse outcomes in patients who underwent PCI. These findings underscore the importance of achieving target SBP while recognizing that patients with high BPV represent a high-risk group requiring focused monitoring and management to mitigate cardiovascular events.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05935397.

摘要

背景

在接受经皮冠状动脉介入治疗（PCI）的冠心病患者中，实现目标收缩压（SBP）和血压变异性（BPV）对长期临床结局的综合影响仍不明确。本研究旨在探讨实现SBP目标和BPV对接受PCI患者发生心血管事件风险的联合作用。

方法

纳入2012年至2016年间连续接受PCI的患者。根据平均随访SBP（<130或≥130 mmHg）和BPV（根据随访期间SBP标准差的中位数分为低或高）将患者分为四组。主要结局是长达5年的净不良临床事件（NACE；定义为全因死亡、非致命性心肌梗死、非致命性卒中、任何血管重建或大出血）。

结果

在2845例患者中，787例（27.7%）在中位随访5.43年期间发生NACE。无论是否实现目标SBP，BPV高的患者发生长期临床结局的风险均显著增加。此外，SBP≥130 mmHg且BPV高的患者发生5年主要不良心脑血管事件（调整后风险比[HR]，1.342；95%置信区间[CI]，1.067 - 1.688；P = 0.012）和NACE（调整后HR，1.262；95% CI，1.036 - 1.537；P = 0.021）的风险显著高于SBP<130 mmHg且BPV低的患者。