Night-time blood pressure and target organ damage: a comparative analysis of absolute blood pressure and dipping status
Night-time blood pressure and target organ damage: a comparative analysis of absolute blood pressure and dipping status
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DOI：
10.1097/hjh.0000000000000690
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发表时间：
2015-11-01
影响因子：
4.9
通讯作者：
Kearney, Patricia M.
中科院分区：
文献类型：
--
作者：
O'Flynn, Anne Marie;Dolan, Eamon;Kearney, Patricia M.
背景：血压昼夜节律模式异常的预后意义已得到公认。迄今为止的研究集中在夜间血压下降和绝对夜间血压水平;然而，这些变量中的哪一个应该是治疗的主要目标仍不清楚。本研究的目的是确定是否浸渍状态或绝对夜间血压水平有一个更强的关联与亚临床靶器官damage（TOD）.Methods：Mitchelstown队列研究心血管健康的成年人群样本招募从初级保健。夜间血压按下降状态分类。亚临床TOD定义为ECG上Cornell产品左心室肥厚（LVH）电压标准和尿白蛋白：肌酐比值（ACR）至少1.1mg/mmol。多变量Logistic回归分析被用来评估夜间BP和TOD.Results之间的关联：2047参与者，1207（响应率59%），进行了24小时动态血压监测。我们排除了161项研究，因为数据不完整。在1046名参与者中，178名（17%）有TOD的证据。夜间SBP每升高10 mmHg，TOD的几率就会增加。比值比（OR）ACR ≥ 1.1mg/mmol 1.5 [95%可信区间（95%CI）1.2-1.8]和OR LVH 1.4（95%CI 1.1-1.8）。结论：绝对血压水平可能是夜间血压相关风险的一个上级早期标志物。需要进行干预性研究，以确定专门针对夜间绝对血压水平是否有益于预防临床重要结局。
Background:The prognostic significance of abnormal circadian blood pressure (BP) patterns is well established. Research to date has focused on both nocturnal dipping and absolute night-time BP levels; however, which of these variables should be the primary target for therapy remains unclear. The aim of this study is to determine whether dipping status or absolute night-time BP levels have a stronger association with subclinical target organ damage (TOD).Methods:The Mitchelstown Cohort was established to examine cardiovascular health in an adult population sample recruited from primary care. Night-time BP was categorized by dipping status. Subclinical TOD was defined as Cornell Product left ventricular hypertrophy (LVH) voltage criteria on ECG and urine albumin : creatinine ratio (ACR) at least 1.1mg/mmol. Multivariable logistic regression analysis was used to assess the association between night-time BP and TOD.Results:Of 2047 participants, 1207 (response rate 59%), underwent 24-h ambulatory BP monitoring. We excluded 161 studies due to incomplete data. Of 1046 participants, 178 (17%) had evidence of TOD. Each 10-mmHg rise in night-time SBP increased the odds of TOD. Odds ratio (OR) ACR at least 1.1mg/mmol 1.5 [95% confidence interval (95% CI) 1.2-1.8] and OR LVH 1.4 (95% CI 1.1-1.8).Conclusion:Absolute BP level rather than dipping status may be a superior early marker of risk associated with night-time BP. Interventional studies are required to determine whether there is a benefit in specifically targeting absolute night-time BP levels to prevent clinically important outcomes.