Fabsitz Richard R, Reese Jessica A, Leidner Jean, Klug Marilyn G, Zhang Ying, Suchy-Dicey Astrid M, Devereux Richard B, Best Lyle G, Basson Marc D
Missouri Breaks Industries Research, Inc 10606 Springmann Dr, Fairfax, VA 22030 (email:
University of Oklahoma, Oklahoma City.
Prev Chronic Dis. 2025 Jun 26;22:E30. doi: 10.5888/pcd22.240512.
Recent literature suggests blood pressure variability (BPV) is an independent risk factor for cardiovascular disease (CVD). Ours is the first study to assess the prognostic value of the intraindividual SD of systolic blood pressure (SBPSD) and diastolic blood pressure (DBPSD) in American Indians.
We computed BPV for 3,352 American Indians who had 8 nonurgent visit-to-visit blood pressure checks according to their electronic health records, and linked those measurements with Strong Heart Study cohort data. We used Cox proportional hazards models to determine whether the risk of all-cause mortality, CVD mortality, or major adverse cardiovascular events (MACE), was different for SBPSD and DBPSD quartiles, while controlling for covariates.
Mean participant age was 54.5 years (SD = 17.3), 66% were female, mean SBPSD was 13.47 (SD = 5.71), and mean DBPSD was 8.05 (SD = 3.02). Over the 20-year follow-up, 45.4% died, 14.6% experienced CVD-related mortality, and 20.8% experienced MACE. Compared with the lowest SBPSD quartile (quartile 1), the risk of all-cause mortality was 35% higher for the highest quartile (quartile 4), while controlling for covariates (HR = 1.35; 95% CI, 1.13-1.61). The risk of CVD mortality and MACE was higher for quartile 4 SBPSD compared with quartile 1 (CVD mortality, HR = 1.81, 95% CI, 1.29-2.53; MACE HR = 1.39, 95 % CI, 1.07-1.80). The risk for quartile 4 DBPSD was not significant for these outcomes (all-cause mortality, HR = 1.15, 95% CI, 0.97-1.36; CVD mortality, HR=1.22, 95% CI, 0.91-1.65; MACE, HR = 1.11, 95% CI, 0.87-1.40).
Our study identified SBPSD as a significant risk factor for all-cause mortality, cardiovascular mortality, and MACE, whereas DBPSD in our cohort of American Indian subjects was not a significant risk factor after adjustment for covariates.
近期文献表明血压变异性（BPV）是心血管疾病（CVD）的独立危险因素。我们的研究是首次评估美国印第安人收缩压个体内标准差（SBPSD）和舒张压个体内标准差（DBPSD）的预后价值。
我们根据电子健康记录，为3352名接受过8次非紧急就诊时血压检查的美国印第安人计算了BPV，并将这些测量值与强心脏研究队列数据相联系。我们使用Cox比例风险模型来确定SBPSD和DBPSD四分位数的全因死亡率、CVD死亡率或主要不良心血管事件（MACE）风险是否存在差异，同时对协变量进行控制。
参与者的平均年龄为54.5岁（标准差=17.3），66%为女性，平均SBPSD为13.47（标准差=5.71），平均DBPSD为8.05（标准差=3.02）。在20年的随访中，45.4%的人死亡，14.6%的人经历了CVD相关死亡，20.8%的人经历了MACE。与最低SBPSD四分位数（四分位数1）相比，在控制协变量的情况下，最高四分位数（四分位数4）的全因死亡风险高35%（风险比=1.35；95%置信区间，1.13 - 1.61）。与四分位数1相比，四分位数4的SBPSD发生CVD死亡和MACE的风险更高（CVD死亡，风险比=1.81，95%置信区间，1.29 - 2.53；MACE风险比=1.39，95%置信区间，1.07 - 1.80）。四分位数4的DBPSD在这些结果中差异不显著（全因死亡率，风险比=1.15，95%置信区间，0.97 - 1.36；CVD死亡率，风险比=1.22，95%置信区间，0.91 - 1.65；MACE，风险比=1.11，95%置信区间，0.87 - 1.40）。
我们的研究确定SBPSD是全因死亡率、心血管死亡率和MACE的重要危险因素，而在我们的美国印第安人队列中，调整协变量后DBPSD不是重要危险因素。
