Frattola A, Parati G, Cuspidi C, Albini F, Mancia G
Centro Fisiologia Clinica e Ipertensione, Ospedale Maggiore, Cattedra di Medicina Interna, Milan, Italy.
J Hypertens. 1993 Oct;11(10):1133-7. doi: 10.1097/00004872-199310000-00019.
Evaluation of the prognostic value of 24-h blood pressure averages and 24-h blood pressure variability.
After an initial thorough clinical and laboratory evaluation which included 24-h continuous ambulatory blood pressure monitoring, a group of hypertensive patients were re-examined after an average of 7.4 years. End-organ damage at the follow-up visit was related to different measures of blood pressure levels and variability obtained at the initial or the follow-up visit or both.
Seventy-three patients with essential hypertension of variable severity, in whom ambulatory blood pressure was monitored intra-arterially for 24 h (Oxford technique) were re-examined at a follow-up visit (including echocardiographic assessment of left ventricular mass index) 1-13 years later (mean 7.4 years). The severity of end-organ damage was quantified by a score and related to clinic blood pressure at follow-up and to (1) clinic blood pressure, (2) 24-h blood pressure mean, (3) 24-h short-term and long-term blood pressure variability, and (4) end-organ damage, all assessed at the initial visit (multiple regression analysis).
The set of independent variables considered was significantly related to end-organ damage at follow-up (R = 0.51). The individual variables most important in determining end-organ damage at follow-up were clinic blood pressure at the follow-up visit (P < 0.01), the initial level of end-organ damage (P < 0.05) and long-term blood pressure variability (among half-hour standard deviation of 24-h mean blood pressure) at the initial evaluation (P < 0.05). The prognostic individual weight of the other haemodynamic parameters considered was less and not statistically significant.
The results confirm that the level of blood pressure achieved by treatment and the degree of end-organ damage at the time of initial evaluation are important determinants of future end-organ damage related to hypertension. They also constitute the first longitudinal evidence that the cardiovascular complications of hypertension may depend on the degree of 24-h blood pressure variability.
评估24小时平均血压及24小时血压变异性的预后价值。
在进行了包括24小时动态血压监测在内的初步全面临床和实验室评估后，一组高血压患者在平均7.4年后接受复查。随访时的靶器官损害与在初次就诊时、随访时或两者均获得的不同血压水平及变异性测量值相关。
73例不同严重程度的原发性高血压患者，采用牛津技术进行了24小时动脉内动态血压监测，在1至13年后（平均7.4年）进行随访复查（包括超声心动图评估左心室质量指数）。通过评分对靶器官损害的严重程度进行量化，并将其与随访时的诊室血压以及（1）诊室血压、（2）24小时平均血压、（3）24小时短期和长期血压变异性、（4）初次就诊时评估的靶器官损害（多元回归分析）相关联。
所考虑的一组自变量与随访时的靶器官损害显著相关（R = 0.51）。在确定随访时靶器官损害方面最重要的个体变量是随访时的诊室血压（P < 0.01）、初次评估时的靶器官损害初始水平（P < 0.05）以及初次评估时的长期血压变异性（24小时平均血压半小时标准差）（P < 0.05）。所考虑的其他血流动力学参数的预后个体权重较小且无统计学意义。
结果证实，治疗所达到的血压水平以及初次评估时的靶器官损害程度是未来与高血压相关的靶器官损害的重要决定因素。它们还首次提供了纵向证据，表明高血压的心血管并发症可能取决于24小时血压变异性的程度。
