Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations:: a meta-analysis of 7030 individuals
Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations:: a meta-analysis of 7030 individuals
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DOI：
10.1097/hjh.0b013e3281c49da5
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发表时间：
2007-08-01
影响因子：
4.9
通讯作者：
Staessen, Jan A.
中科院分区：
文献类型：
--
作者：
Hansen, Tine W.;Kikuya, Masahiro;Staessen, Jan A.
目的探讨收缩压和舒张压对常规（CBP）和日间（10-20 h）动态（ABP）测量的多变量校正预测值。方法我们从比利时、丹麦、日本和瑞典随机招募了7030名受试者（平均年龄56.2岁，44.8%为女性）。我们建立了动态血压和心血管结局的国际数据库。结果在随访期间（中位数= 9.5年），932例受试者死亡。CBP和ABP均不能预测总死亡率，其中60.9%是由于非心血管原因。致死性和非致死性心血管事件的发生率合计为863例（228例死亡、326例卒中和309例心脏事件）。在多变量校正的连续分析中，CBP和ABP均预测心血管、脑血管、心脏和冠状动脉事件。然而，在完全校正的模型中，包括CBP和ABP，CBP失去了其预测价值（P >= 0.052），而收缩压和舒张压ABP保留了其预后意义（P = 0.21）。在校正的分类分析中，血压正常组（CBP < 140/90 mmHg和ABP < 135/ 85 mmHg）。白大衣高血压患者所有心血管事件的校正风险比为1.22 [95%置信区间（CI）= 0.96-1.53; P = 0.09（>= 140/90且< 135/85 mmHg）; 1.62（95%CI = 1.35-1.96; P < 0.0001）（< 140/90和> 135/85 mmHg）;和1.80（95% CI = 1.59-2.03; P < 0.0001）持续性高血压结论ABP对心血管事件的预测能力上级于CBP，但对总死亡率和非心血管死亡率的预测能力不及CBP。心血管风险从血压正常的白大衣和隐性高血压逐渐增加到持续性高血压。
Objective To investigate the multivariate-adjusted predictive value of systolic and diastolic blood pressures on conventional (CBP) and daytime (10-20 h) ambulatory (ABP) measurement.Methods We randomly recruited 7030 subjects (mean age 56.2 years; 44.8% women) from populations in Belgium, Denmark, Japan and Sweden. We constructed the International Database on Ambulatory blood pressure and Cardiovascular Outcomes.Results During follow-up (median = 9.5 years), 932 subjects died. Neither CBP nor ABP predicted total mortality, of which 60.9% was due to noncardiovascular causes. The incidence of fatal combined with nonfatal cardiovascular events amounted to 863 (228 deaths, 326 strokes and 309 cardiac events). In multivariate-adjusted continuous analyses, both CBP and ABP predicted cardiovascular, cerebrovascular, cardiac and coronary events. However, in fully-adjusted models, including both CBP and ABP, CBP lost its predictive value (P >= 0.052), whereas systolic and diastolic ABP retained their prognostic significance (P = 0.21). In adjusted categorical analyses, normotension was the referent group (CBP < 140/90 mmHg and ABP < 135/ 85 mmHg). Adjusted hazard ratios for all cardiovascular events were 1.22 [95% confidence interval (CI) = 0.96-1.53; P = 0.09] for white-coat hypertension (>= 140/90 and < 135/85 mmHg); 1.62 (95% CI = 1.35-1.96; P < 0.0001) for masked hypertension (< 140/90 and > 135/85 mmHg); and 1.80 (95% CI = 1.59-2.03; P < 0.0001) for sustained hypertension (>= 140/90 and >= 135/85 mmHg).Conclusions ABP is superior to CBP in predicting cardiovascular events, but not total and noncardiovascular mortality. Cardiovascular risk gradually increases from normotension over white-coat and masked hypertension to sustained hypertension.