The cumulative blood pressure load and target organ damage in patients with essential hypertension
The cumulative blood pressure load and target organ damage in patients with essential hypertension
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原发性高血压患者累积血压负荷及靶器官损害
DOI：
10.1111/jch.13875
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发表时间：
2020-05-19
影响因子：
2.8
通讯作者：
Zeng, Chunyu
中科院分区：
文献类型：
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作者：
Zhou, Bingqing;Li, Chuanwei;Zeng, Chunyu
血压曲线下面积与靶器官损伤相关，但准确估计其值具有挑战性。本研究旨在提高血压曲线下面积预测高血压靶器官损害的实用性。这项回顾性队列研究包括634例原发性高血压>1年的连续患者。靶器官损害定义为存在左心室肥大和/或颈动脉斑块。我们评估了累积血压负荷（来自动态血压监测数据）与靶器官损害之间的相关性。使用受试者操作特征曲线评估累积血压负荷对靶器官损伤的预测价值。左心室肥厚和颈动脉斑块分别出现在392例（61.8%）和316例（49.8%）患者中。左心室肥厚和/或颈动脉斑块患者的24小时血压、夜间累积收缩压和夜间累积脉压负荷较高。夜间累积收缩压负荷是左心室肥大（比值比= 1.002，95%置信区间：1.001 - 1.004; P = .000）和颈动脉斑块（比值比= 1.003，95%置信区间：1.002 - 1.007; P = .007）的独立预测因子。相对于平均血压，夜间累积收缩压和累积脉压负荷在预测高血压靶器官损害方面具有上级优势。因此，累积血压负荷是一个更好的血压后果的指标，夜间累积收缩压和累积脉压负荷可以预测靶器官损害。
The area under the blood pressure curve is associated with target organ damage, but accurately estimating its value is challenging. This study aimed to improve the utility of the area under the blood pressure curve to predict hypertensive target organ damage. This retrospective cohort study comprised of 634 consecutive patients with essential hypertension for >1 year. Target organ damage was defined as the presence of left ventricular hypertrophy and/or carotid artery plaques. We evaluated the associations between the cumulative blood pressure load, which was derived from ambulatory blood pressure monitoring data, and target organ damage. The predictive value of the cumulative blood pressure load for target organ damage was assessed using receiver operating characteristic curves. Left ventricular hypertrophy and carotid artery plaques were present in 392 (61.8%) and 316 (49.8%) patients, respectively. Patients with left ventricular hypertrophy and/or carotid artery plaques had higher 24‐hour blood pressure, nocturnal cumulative systolic blood pressure, and nocturnal cumulative pulse pressure load. The nocturnal cumulative systolic blood pressure load was an independent predictor of left ventricular hypertrophy (odds ratio = 1.002, 95% confidence interval: 1.001‐1.004; P = .000) and carotid artery plaques (odds ratio = 1.003, 95% confidence interval: 1.002‐1.007; P = .007). The nocturnal cumulative systolic blood pressure and cumulative pulse pressure load, relative to mean blood pressure, were superior in predicting hypertensive target organ damage. Hence, the cumulative blood pressure load is a better indicator of blood pressure consequences, and the nocturnal cumulative systolic blood pressure and cumulative pulse pressure loads could predict target organ damage.