Prognostic Value of the Morning Blood Pressure Surge in 5645 Subjects From 8 Populations
Prognostic Value of the Morning Blood Pressure Surge in 5645 Subjects From 8 Populations
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来自 8 个人群的 5645 名受试者的早晨血压激增的预后价值
DOI：
10.1161/hypertensionaha.109.137273
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发表时间：
2010-04-01
期刊：
影响因子：
8.3
通讯作者：
Staessen, Jan A.
中科院分区：
文献类型：
--
作者：
Li, Yan;Thijs, Lutgarde;Staessen, Jan A.
先前关于早晨血压激增(MS)的预后意义的研究得出了不一致的结果。使用动态血压与心血管结局相关的国际数据库，我们分析了8个国家随机招募的5645名受试者(平均年龄：53.0岁，54.0%是女性)。夜间血压最低的晨间血压与夜间血压最低的晨间血压差值与睡前多发性硬化症的差值分别为睡眠期和预醒期血压差值。我们计算了多变量调整后的风险比，比较了种族和性别相关的多发性硬化症的风险相对于整个研究人群的平均风险。在随访期间(中位数：11.4年)，发生了785例死亡和611例致命性和非致命性心血管事件。在考虑协变量和昼夜收缩压比值的情况下，≥为37.0 mm Hg时，全因死亡的危险性比为1.32(95%CI：1.09~1.59；P=0.004)。心血管和非心血管死亡的危险比分别为1.18(95%CI：0.87~1.61；P=0.3)和1.42(95%CI：1.11~1.8；P=0.005)。对于所有心血管、心脏、冠状动脉和脑血管事件，收缩期睡眠过多综合征前十位的风险比分别为1.3(95%CI：1.0 6~1.6 0；P=0.0 1)、1.5 2(95%CI：1.15~2.0 0；P=0.004)、1.45(95%CI：1.0 4~2.0 3；P=0.0 3)和0.95(95%CI：0.6 8~1.32；P=0.74)。对觉醒前的收缩多发性硬化和舒张期多发性硬化的分析得出了一致的结果。总而言之，大于90%的MS显著且独立地预测心血管结果，并可能有助于通过动态血压监测进行危险分层。
Previous studies on the prognostic significance of the morning blood pressure surge (MS) produced inconsistent results. Using the International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome, we analyzed 5645 subjects (mean age: 53.0 years; 54.0% women) randomly recruited in 8 countries. The sleep-through and the preawakening MS were the differences in the morning blood pressure with the lowest nighttime blood pressure and the preawakening blood pressure, respectively. We computed multivariable-adjusted hazard ratios comparing the risk in ethnic- and sex-specific deciles of the MS relative to the average risk in the whole study population. During follow-up (median: 11.4 years), 785 deaths and 611 fatal and nonfatal cardiovascular events occurred. While accounting for covariables and the night:day ratio of systolic pressure, the hazard ratio of all-cause mortality was 1.32 (95% CI: 1.09 to 1.59; P=0.004) in the top decile of the systolic sleep-through MS (≥37.0 mm Hg). For cardiovascular and noncardiovascular death, these hazard ratios were 1.18 (95% CI: 0.87 to 1.61; P=0.30) and 1.42 (95% CI: 1.11 to 1.80; P=0.005). For all cardiovascular, cardiac, coronary, and cerebrovascular events, the hazard ratios in the top decile of the systolic sleep-through MS were 1.30 (95% CI: 1.06 to 1.60; P=0.01), 1.52 (95% CI: 1.15 to 2.00; P=0.004), 1.45 (95% CI: 1.04 to 2.03; P=0.03), and 0.95 (95% CI: 0.68 to 1.32; P=0.74), respectively. Analysis of the preawakening systolic MS and the diastolic MS generated consistent results. In conclusion, a MS above the 90th percentile significantly and independently predicted cardiovascular outcome and might contribute to risk stratification by ambulatory blood pressure monitoring.