Impaired diurnal blood pressure variation and all-cause mortality
Impaired diurnal blood pressure variation and all-cause mortality
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DOI：
10.1038/ajh.2007.7
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发表时间：
2008-01-01
影响因子：
3.2
通讯作者：
Vidt, Donald G.
中科院分区：
文献类型：
--
作者：
Brotman, Daniel J.;Davidson, Michael B.;Vidt, Donald G.
背景技术大多数健康人在夜间表现出收缩压（SBP）下降。日间平均血压值下降 < 10%，即 11 次非下降”与肾脏疾病和心血管事件相关。我们假设非下降可以预测全因死亡率。方法 包括 1994 年至 2004 年间在克利夫兰诊所连续转诊进行动态血压 (BP) 监测的患者。平均白天 (6 (AM)-11 (PM)) 和夜间 (11 (PM)-6 (AM)) 我们将每日血压变化计算为连续变量（（平均白天收缩压 - 平均夜间收缩压）/（平均白天收缩压））x 100%，并将“非浸渍”定义为夜间收缩压下降 < 10%；表现出非浸渍的受试者被定义为“非浸渍”，其他受试者定义为“浸渍”。 “全因死亡率是通过社会保障死亡指数确定的。结果在研究中纳入的 621 名患者中，261 名杓型患者和 360 名非杓型患者。非杓型患者年龄较大 (P < 0.0001)，更有可能是非白人 (P < 0.05)，并且吸烟、糖尿病、高血压、冠状动脉疾病、充血性心力衰竭和肾功能不全的比例较高 (P在平均 6.3 年的随访中，61 名患者死亡，包括 10 名杓型患者 (3.8%) 和 51 名非杓型患者 (14.2%)。根据从第 75 个百分位到第 25 个百分位数的下降百分比，未经调整的死亡风险比为 2.22（95% 置信区间 1.64-2.95；P < 0.0001）。在调整合并症（包括平均 24 小时收缩压和肾功能）后，这一结果减弱：调整后的风险比为 1.62（1.14-2.24；P < 0.005）。结论：昼夜血压变化减弱是死亡的强有力预测因素，但这在很大程度上可能是由于其与其他心血管危险因素的关联。
BACKGROUNDMost healthy people exhibit a decrease in systolic blood pressure (SBP) at night. A drop of < 10% from mean daytime values, 11 non-dipping,"is associated with kidney disease and cardiovascular events. We hypothesized that non-dipping would predict ail-cause mortality.METHODSConsecutive patients referred for ambulatory blood pressure (BP) monitoring at the Cleveland Clinic between 1994 and 2004 were included. Mean daytime (6 (AM)-11 (PM)) and nighttime (11 (PM)-6 (AM)) SBP values were calculated. We examined diurnal BP variation as a continuous variable, ((Mean daytime SBP - Mean nighttime SBP)/ (Mean daytime SBP)) x 100%, and also as a categorical variable, defining "non-dipping"as a nocturnal SBP drop of < 10%; subjects who exhibited non-dipping were defined as "non-dippers" and the others as "dippers' "All-cause mortality was ascertained from the Social Security Death Index.RESULTSOf the 621 patients included in the study, 261 were dippers and 360 were non-dippers. Non-dippers were older (P < 0.0001), more likely to be non-white (P < 0.05), and had higher rates of smoking, diabetes, hypertension, coronary artery disease, congestive heart failure, and renal insufficiency (P < 0.01 for all). Over a mean follow-up of 6.3 years, 61 patients died, including 10 dippers (3.8%) and 51 non-dippers (14.2%). The unadjusted hazard ratio for death based upon a decrement in the dipping percentage from the 75th to 25th percentile was 2.22 (95% confidence interval 1.64-2.95; P < 0.0001).This was attenuated after adjustment for comorbid conditions, including mean 24-h SBP and renal function: adjusted hazard ratio 1.62 (1.14-2.24; P < 0.005).CONCLUSIONSBlunted diurnal BP variation is a strong predictor of death, but this may be accounted for, in large part, by its association with other cardiovascular risk factors.