Variability independent of mean blood pressure as a real-world measure of cardiovascular risk.
Variability independent of mean blood pressure as a real-world measure of cardiovascular risk.
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DOI：
10.1016/j.eclinm.2022.101442
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发表时间：
2022-06
影响因子：
15.1
通讯作者：
中科院分区：
文献类型：
--
作者：
在使用标准化血压测量的队列研究和临床试验中，个体水平的血压(BP)变异性与平均血压水平无关，与心血管事件风险增加相关。在现实世界的临床实践环境中，血压变异性与心血管风险的关系程度尚不清楚。我们试图利用来自电子健康记录(EHR)的临床生成数据来确定临床实践中的血压变异性是否与心血管不良结局相关。我们确定了2013至2019年间在南加州一个学术医疗中心连续跟踪的42,482名患者，并计算了他们在研究期间的前3年中独立于平均值(VIM)的收缩和舒张压变异性。然后，我们进行了多变量COX比例风险回归，以检验VIM与相关的综合和个体结果(发生心肌梗死、心力衰竭、中风和死亡)之间的关系。收缩压(HR，95%可信区间1.22，1.17-1.28)和舒张期VIM(1.24，1.19-1.30)均与综合预后及所有单项预后指标呈正相关。这些发现对年龄、性别和临床合并症的分层很有说服力。在采用时移随访期的敏感性分析中，VIM仍然与收缩压(1.15，1.11-1.20)和舒张压(1.18，1.13-1.22)值的综合结果显著相关。来自临床产生的数据的VIM仍然与不良的心血管结局有关，并代表着一种超出平均血压的风险标记，包括在重要的人口统计学和临床亚组中。从非标准化BP读数得出的VIM的预测能力表明，这种测量方法在现实世界的实践环境中用于风险分层是有用的，尽管不能排除来自未测量变量的残留混杂。本研究部分资金由美国国立卫生研究院资助：R01-HL134168、R01-HL131532、R01-HL143227、R01-HL142983、U54-AG065141；R01-HL153382、K23-HL136853、K23-HL153888和K99-HL157421；中国奖学金委员会拨款201806260086；芬兰科学院(批准号：321351)；埃米尔·阿尔托宁基金会；芬兰心血管研究基金会。
Individual-level blood pressure (BP) variability, independent of mean BP levels, has been associated with increased risk for cardiovascular events in cohort studies and clinical trials using standardized BP measurements. The extent to which BP variability relates to cardiovascular risk in the real-world clinical practice setting is unclear. We sought to determine if BP variability in clinical practice is associated with adverse cardiovascular outcomes using clinically generated data from the electronic health record (EHR). We identified 42,482 patients followed continuously at a single academic medical center in Southern California between 2013 and 2019 and calculated their systolic and diastolic BP variability independent of the mean (VIM) over the first 3 years of the study period. We then performed multivariable Cox proportional hazards regression to examine the association between VIM and both composite and individual outcomes of interest (incident myocardial infarction, heart failure, stroke, and death). Both systolic (HR, 95% CI 1.22, 1.17–1.28) and diastolic VIM (1.24, 1.19–1.30) were positively associated with the composite outcome, as well as all individual outcome measures. These findings were robust to stratification by age, sex and clinical comorbidities. In sensitivity analyses using a time-shifted follow-up period, VIM remained significantly associated with the composite outcome for both systolic (1.15, 1.11–1.20) and diastolic (1.18, 1.13–1.22) values. VIM derived from clinically generated data remains associated with adverse cardiovascular outcomes and represents a risk marker beyond mean BP, including in important demographic and clinical subgroups. The demonstrated prognostic ability of VIM derived from non-standardized BP readings indicates the utility of this measure for risk stratification in a real-world practice setting, although residual confounding from unmeasured variables cannot be excluded. This study was funded in part by National Institutes of Health grants R01-HL134168, R01-HL131532, R01-HL143227, R01-HL142983, U54-AG065141; R01-HL153382, K23-HL136853, K23-HL153888, and K99-HL157421; China Scholarship Council grant 201806260086; Academy of Finland (Grant no: 321351); Emil Aaltonen Foundation; Finnish Foundation for Cardiovascular Research.
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影响因子：
5.7
作者：
Burkard, Thilo;Mayr, Michael;Vischer, Annina Salome
通讯作者：
Vischer, Annina Salome
影响因子：
39
作者：
Drawz, Paul E.;Agarwal, Anil;Pajewski, Nicholas M.
通讯作者：
Pajewski, Nicholas M.
影响因子：
2.8
作者：
Tang, Olive;Juraschek, Stephen P.;Miller, Edgar R., III
通讯作者：
Miller, Edgar R., III
DOI：
10.1136/bmj.i4098
发表时间：
2016-08-09
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Stevens SL;Wood S;Koshiaris C;Law K;Glasziou P;Stevens RJ;McManus RJ
通讯作者：
McManus RJ
影响因子：
5.4
作者：
Mena LJ;Felix VG;Melgarejo JD;Maestre GE
通讯作者：
Maestre GE