Visit-to-Visit Blood Pressure Variability, Carotid Atherosclerosis, and Cardiovascular Events in the European Lacidipine Study on Atherosclerosis
Visit-to-Visit Blood Pressure Variability, Carotid Atherosclerosis, and Cardiovascular Events in the European Lacidipine Study on Atherosclerosis
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DOI：
10.1161/circulationaha.112.107565
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发表时间：
2012-07-31
期刊：
影响因子：
37.8
通讯作者：
Zanchetti, Alberto
中科院分区：
文献类型：
--
作者：
Mancia, Giuseppe;Facchetti, Rita;Zanchetti, Alberto
背景——据报道，在接受高心血管风险治疗的高血压患者中，心血管事件的发生率与就诊血压（BP）变异性有关。我们研究了每次就诊血压变异性对于接受治疗的轻度至中度高血压患者是否具有预后重要意义，这些患者的治疗目的是避免事件发生，同时预防或延缓器官损伤的进展。方法和结果-我们分析了欧洲拉西地平动脉粥样硬化研究 (ELSA) 的汇总数据，该研究是一项为期 4 年的随机、双盲试验，研究拉西地平或阿替洛尔对超声造影颈动脉内膜中层的影响厚度。通过分别以 6 个月（诊所血压）和 12 个月（24 小时血压）间隔获得的平均治疗收缩压 (SBP) 的变异系数或 SD 来评估访问间血压变异性（分别为 1521 名和 1264 名患者）。在多变量线性回归模型中，治疗结束时的颈动脉内膜中层厚度与治疗时平均收缩压或 24 小时收缩压相关，但收缩压变异系数或 SD 不相关。内膜中层厚度从平均治疗诊所或 24 小时 SBP 的最低四分位数到最高四分位数逐渐增加（调整趋势 P=0.046 和 0.048），但不沿着 SBP 变异系数或 SD 的相似四分位数增加。在多变量逻辑回归模型中，平均血压（而非变异性）与心血管结果相关。结论：在轻度至中度高血压患者中，颈动脉内膜中层厚度和心血管结果与平均门诊或通过治疗实现的动态收缩压相关，但与治疗期间每次就诊或24小时血压变异性无关。因此，当血压适度升高时，两次就诊之间血压控制的不一致对预后的影响不如长期平均血压水平那么重要。 （流通。2012 年；126：569-578。）
Background-In high-cardiovascular-risk treated hypertensive patients, the incidence of cardiovascular events has been reported to relate to visit-to-visit blood pressure (BP) variability. We investigated whether visit-to-visit BP variability is prognostically important in treated mildly to moderately hypertensive patients in whom treatment aims at avoiding events but also at preventing or delaying progression of organ damage.Methods and Results-We analyzed the pooled data from the European Lacidipine Study on Atherosclerosis (ELSA), a randomized, double-blind 4-year trial of the effect of lacidipine or atenolol on echographic carotid intima-media thickness. Visit-to-visit BP variability was assessed by the coefficient of variation or the SD of the mean on-treatment systolic BP (SBP) obtained at 6- (clinic BP) and 12- (24 hours BP) month intervals, respectively (1521 and 1264 patients, respectively). In a multivariable linear regression model, mean on-treatment clinic or 24-hour SBP, but not SBP coefficient of variation or SD, was associated with end-of-treatment carotid intima-media thickness. Intima-media thickness increased progressively from the lowest to highest quartile of mean on-treatment clinic or 24-hour SBP (adjusted P for trend=0.046 and 0.048) but not along similar quartiles of SBP coefficient of variation or SD. In a multivariable logistic regression model, mean BP, but not variability, was associated with cardiovascular outcomes.Conclusions-In mildly to moderately hypertensive patients, carotid intima-media thickness and cardiovascular outcomes were related to the mean clinic or ambulatory SBP achieved by treatment but not to on-treatment visit-to-visit clinic or 24-hour BP variability. Thus, when BP is modestly elevated, inconsistency of BP control between visits plays a less important prognostic role than long-term average BP levels. (Circulation. 2012;126:569-578.)