Prognostic importance of long-term SBP variability in high-risk hypertension.
Prognostic importance of long-term SBP variability in high-risk hypertension.
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DOI：
10.1097/hjh.0000000000002552
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发表时间：
2020-11
影响因子：
4.9
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中科院分区：
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除了高血压变异性（BPV），低BPV与选定的高危患者的不良心血管预后相关。我们在收缩压干预试验（SPRINT）中采用非线性方法，以BPV作为连续变量，探讨了这一问题。在每季度访视时计算长期收缩期BPV（SBPV）（变异系数，CoV %），直至发生致死性/非致死性心血管事件或全因死亡，不包括滴定期和缺失访视的患者。我们使用带有惩罚平滑样条的考克斯比例风险模型来针对SBPV（自变量）的连续体来塑造结局的风险。使用非线性模型得出的参考范围计算校正的风险比（aHR，95% CI）。进行了基于倾向评分匹配（PSM）的敏感性分析。SBPV与致死性/非致死性心血管事件的相关性呈J形，而与全因死亡率的相关性呈线性。然而，经过多变量校正后，仅有的显著相关性仍然是低SBPV（CoV <5%）与心血管事件（风险比1.85，95% CI 1.24-2.75，P= 0.003），高SBPV（CoV >10%），复合心血管事件和全因死亡率（风险比1.35，95%CI 1.02-1.80; P= 0.037）。低SBPV与缺血性心脏病相关（风险比2.76，95%CI 1.55- 4.91; P< 0.001）。在PSM队列中，SBPV与心血管事件之间存在显著的U型相关性。非线性模型表明，低和高的长期SBPV在SPRINT的高危高血压个体中具有预后相关性。需要进行随机试验来测试这些发现及其潜在的治疗意义。
In addition to high blood pressure variability (BPV), low BPV was associated with adverse cardiovascular prognosis in selected high-risk patients. We explored this issue in the Systolic Blood Pressure Intervention Trial (SPRINT) using a nonlinear approach with BPV as a continuous variable. Long-term systolic BPV (SBPV) (coefficient of variation, CoV %) was calculated on quarterly visits until a fatal/nonfatal cardiovascular event or all-cause mortality, excluding titration period and patients with missing visits. We used Cox proportional hazard models with penalized smoothing splines to shape the risk of outcomes against the continuum of SBPV (independent variable). Adjusted hazard ratios (aHR, 95% CI) were calculated using the reference range derived from the nonlinear model. Sensitivity analysis based on propensity score matching (PSM) was performed. The association of SBPV with fatal/nonfatal cardiovascular events was J-shaped, whereas that with all-cause mortality was linear. After multivariate adjustment, however, the only significant associations remained that of low SBPV (CoV <5%) with cardiovascular events (hazard ratio 1.85, 95% CI 1.24–2.75, P= 0.003), and of high SBPV (CoV >10%) with the composite of cardiovascular events and all-cause mortality (hazard ratio 1.35, 95% CI 1.02–1.80; P= 0.037). Low SBPV was associated with ischemic heart disease (hazard ratio 2.76, 95% CI 1.55– 4.91; P< 0.001). There was a significant U-shaped association of SBPV with cardiovascular events in the PSM cohort. Nonlinear modeling indicates that low and high long-term SBPV have prognostic relevance in high-risk hypertensive individuals from SPRINT. Randomized trials are needed to test these findings and their potential therapeutic implications.