Within-subject blood pressure level--not variability--predicts fatal and nonfatal outcomes in a general population.
Within-subject blood pressure level--not variability--predicts fatal and nonfatal outcomes in a general population.
复制标题
DOI：
10.1161/hypertensionaha.112.202143
复制
发表时间：
2012-11
期刊：
影响因子：
--
通讯作者：
Staessen JA
中科院分区：
文献类型：
--
作者：
Schutte R;Thijs L;Liu YP;Asayama K;Jin Y;Odili A;Gu YM;Kuznetsova T;Jacobs L;Staessen JA
为了评估血压变异性的预后意义，我们跟踪了以家庭为基础的随机人群样本中的健康结果，这些样本代表了普通人群(n=2944；平均年龄：44.9岁；50.7%的女性)。基线时，在间隔2-4周的2次家访中，每次连续测量5次血压。我们根据与平均值无关的变异性、最大和最小血压之间的差值以及平均实际变异性来评估受试者内总体(10个读数)、就诊内和就诊之间的收缩压变异性。在12年的中位数随访中，发生了401例死亡，311名参与者经历了致命或非致命的心血管事件。总的收缩压变异平均值(SD)为5.45(2.82)个单位、15.87(8.36)mm Hg和4.08(2.05)mm Hg，与平均值、最大和最小血压差以及平均实际变异无关。女性、年龄较大、平均收缩压较高、体重指数较低、有外周动脉病史和使用β阻滞剂是影响收缩压变异性的主要因素。在多变量调整分析中，总体、就诊期间和就诊之间的血压变异性不能预测总死亡率或心血管死亡率，也不能预测任何致命和非致命心血管终点的组合。例如，与总体变异性无关的所有心血管事件的综合风险比分别为1.05(0.96-1.15)、1.06(0.96-1.16)和1.08(0.98-1.19)。相比之下，平均收缩压是所有研究终点的重要预测指标，与血压变异性无关。总而言之，在一个无偏的人群样本中，血压变异性对超过平均收缩压和超过平均收缩压的风险分层没有贡献。
To assess the prognostic significance of blood pressure (BP) variability, we followed health outcomes in a family-based random population sample representative of the general population (n=2944; mean age: 44.9 years; 50.7% women). At baseline, BP was measured 5 times consecutively at each of 2 home visits 2 to 4 weeks apart. We assessed within-subject overall (10 readings), within- and between-visit systolic BP variability from variability independent of the mean, the difference between maximum and minimum BP, and average real variability. Over a median follow-up of 12 years, 401 deaths occurred and 311 participants experienced a fatal or nonfatal cardiovascular event. Overall systolic BP variability averaged (SD) 5.45 (2.82) units, 15.87 (8.36) mm Hg, and 4.08 (2.05) mm Hg for variability independent of the mean, difference between maximum and minimum BP, and average real variability, respectively. Female sex, older age, higher-mean systolic BP, lower body mass index, a history of peripheral arterial disease, and use of β-blockers were the main correlates of systolic BP variability. In multivariable-adjusted analyses, overall and within- and between-visit BP variability did not predict total or cardiovascular mortality or the composite of any fatal plus nonfatal cardiovascular end point. For instance, the hazard ratios for all cardiovascular events combined in relation to overall variability independent of the mean, difference between maximum and minimum BP, and average real variability were 1.05 (0.96–1.15), 1.06 (0.96–1.16), and 1.08 (0.98–1.19), respectively. By contrast, mean systolic BP was a significant predictor of all end points under study, independent of BP variability. In conclusion, in an unbiased population sample, BP variability did not contribute to risk stratification over and beyond mean systolic BP.