A Reverse Dipping Pattern Predicts Cardiovascular Mortality In a Clinical Cohort
A Reverse Dipping Pattern Predicts Cardiovascular Mortality In a Clinical Cohort
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DOI：
10.3346/jkms.2013.28.10.1468
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发表时间：
2013-10-01
影响因子：
4.5
通讯作者：
Shin, Jinho
中科院分区：
文献类型：
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作者：
Kim, Bae Keun;Kim, Yu-Mi;Shin, Jinho
动态血压监测（ABPM）异常下降模式是心血管（CV）的危险因素。然而，其对CV死亡率的影响尚未在临床实践中得到充分的研究，不能作为标准参数。我们评估了韩国一家三级医院异常浸入模式与CV死亡率增加之间的关系。我们的回顾性队列研究纳入了1994年至1996年在韩国首尔汉阳大学医院接受ABPM的401例患者。将患者分为收缩压升高组（收缩压下降< 0%,n = 107），降压组和非降压组（降压0 = 0%,n = 294）。随访期120个月。CV死亡率在上升组为14.0%，在其他组为5.8%。Cox回归分析发现，在调整了年龄、性别、体重指数、高血压、糖尿病、吸烟和高胆固醇血症等因素后，下降模式与CV死亡率之间存在显著关联。上升者的心血管死亡风险高于其他人（RR, 3.02, P = 0.022），但下沉者和非下沉者之间的事件发生率没有差异。这种反向倾斜模式在临床环境中可能比在一般人群中更常见，并且在韩国与CV死亡风险增加密切相关。
An abnormal dipping pattern in ambulatory blood pressure monitoring (ABPM) is a cardiovascular (CV) risk factor. However, its impact on CV mortality has not been investigated sufficiently in clinical practice to be considered a standard parameter. We assessed the association between abnormal dipping patterns and increased CV mortality in a tertiary hospital in Korea. Our retrospective cohort study included 401 patients who underwent ABPM between 1994 and 1996 in Hanyang University Hospital, Seoul, Korea. The patients were classified as risers (< 0% drop in systolic BP; n = 107), and others included dippers and non-dippers (>= 0% drop, n = 294). The follow-up period was 120 months. The frequency of CV mortality was 14.0% in risers and 5.8% in others. A Cox regression analysis found a significant association between dipping pattern and CV mortality, after adjusting for age, gender, body mass index, hypertension, diabetes mellitus, smoking and hypercholesterolemia. Risers were at greater risk of CV death than others (RR, 3.02, P = 0.022), but there was no difference in event rates between dippers and non-dippers. The reverse dipping pattern may be more frequent in clinical settings than in the population at large, and it is strongly associated with increased risk of CV mortality in Korea.