Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure
Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure
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DOI：
10.1161/01.hyp.0000215363.69793.bb
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发表时间：
2006-05-01
期刊：
影响因子：
8.3
通讯作者：
Sega, R
中科院分区：
文献类型：
--
作者：
Mancia, G;Facchetti, R;Sega, R
在Pressioni Arteriose Monitor e Loro Associazion(Pamela)研究中，在1990至1993年间，在一个大的人群样本(n=2051)中同时测量了办公室、家庭和动态血压(BP)值。在接下来的148个月中收集了心血管(CV)和非心血管死亡证明，这使我们能够评估在长期随访中选择性和联合升高这3BP的预后价值。脑血管意外69例，全因死亡233例。与办公室血压正常和24小时血压升高的受试者相比，选择性办公室血压升高(白大衣高血压)、选择性24小时血压升高(隐匿性高血压)以及办公室和24小时血压升高的患者心血管死亡的风险比呈进行性增加。当通过办公室与家庭的BP值确定上述情况时，情况也是如此。在家中选择性抬高血压或反之亦然，这也增加了风险。无论考虑哪种血压，办公室血压、家庭血压和动态血压均正常的受试者和血压升高1、2或全部3血压的受试者的心血管风险和全因死亡风险确实呈进行性增加。在对年龄和性别进行调整后，以及在大多数情况下，在对其他心血管危险因素进行进一步调整后，这一趋势仍然显著。因此，白大衣高血压和隐蔽性高血压，无论是通过办公室和门诊，还是通过办公室和家庭血压来识别，都不是预后无害的。事实上，每一次血压升高(办公室、家庭或门诊)都会增加风险死亡率，这与其他血压升高的风险增加是相加的。
In the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study, office, home, and ambulatory blood pressure (BP) values were measured contemporaneously between 1990 and 1993 in a large population sample (n = 2051). Cardiovascular (CV) and non-CV death certificates were collected over the next 148 months, which allowed us to assess the prognostic value of selective and combined elevation in these 3 BPs over a long follow-up. There were 69 CV and 233 all-cause deaths. Compared with subjects with normal office and 24-hour BP, the hazard ratio for CV death showed a progressive increase in those with a selective office BP elevation (white-coat hypertension), a selective 24-hour BP elevation (masked hypertension), and elevation in both office and 24-hour BP. This was the case also when the above conditions were identified by office versus home BP values. Selective elevation in home versus ambulatory BP or vice versa also carried an increased risk. There was indeed a progressive increase in both CV and all-cause mortality risk from subjects in whom office, home, and ambulatory BP were all normal to those in whom 1, 2, or all 3 BPs were elevated, regardless of which BP was considered. The trends remained significant after adjustment for age and gender, as well as, in most instances, after further adjustment for other cardiovascular risk factors. Thus, white-coat hypertension and masked hypertension, both when identified by office and ambulatory or by office and home BPs, are not prognostically innocent. Indeed, each BP elevation (office, home, or ambulatory) carries an increase in risk mortality that adds to that of the other BP elevations.