Long-term prognostic value of blood pressure variability in the general population - Results of the Pressioni Arteriose Monitorate e Loro Associazioni Study
Long-term prognostic value of blood pressure variability in the general population - Results of the Pressioni Arteriose Monitorate e Loro Associazioni Study
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DOI：
10.1161/hypertensionaha.107.088708
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发表时间：
2007-06-01
期刊：
影响因子：
8.3
通讯作者：
Sega, Roberto
中科院分区：
文献类型：
--
作者：
Mancia, Giuseppe;Bombelli, Michele;Sega, Roberto
心血管预后不仅与24小时平均血压有关，而且与血压变异性有关。然而，数据并不一致，也没有长期的预后研究。2012年，从蒙扎（米兰）人群中随机选择个体，通过间隔20分钟的读数测量24小时动态血压（Spaciros 90207）。通过计算以下内容获得收缩压和舒张压变异性：（1）24小时、白天和夜间平均值的SD;（2）昼夜血压差;和（3）残余或不稳定的血压变异性（傅立叶光谱分析）。致死性心血管和非心血管事件登记了148个月。当调整年龄、性别、24小时平均血压和其他危险因素后，死亡风险与24小时、白天和夜间血压标准差之间没有关系。与此相反，心血管死亡的校正风险与昼夜舒张压差呈负相关（β系数= -0.040; P < 0.02），与残余舒张压变异性呈显著正相关（β系数= 0.175; P < 0.002）。夜间低血压的24小时平均血压衰减和不稳定的舒张压变异性都独立预测死亡风险，其中不稳定的变异性是最重要的因素。我们的数据表明，血压与预后的关系是复杂的，除了24小时平均值之外，还涉及其他现象。他们还提供了第一个证据，表明血压变异性的短期不稳定成分具有预后作用，其增加伴随着心血管风险的增加。
The hypothesis has been advanced that cardiovascular prognosis is related not only to 24-hour mean blood pressure but also to blood pressure variability. Data, however, are inconsistent, and no long-term prognostic study is available. In 2012 individuals randomly selected from the population of Monza (Milan), 24-hour ambulatory blood pressure (Spacelabs 90207) was measured via readings spaced by 20 minutes. Systolic and diastolic blood pressure variability was obtained by calculating the following: (1) the SD of 24-hour, day, and night mean values; (2) the day-night blood pressure difference; and (3) the residual or erratic blood pressure variability (Fourier spectral analysis). Fatal cardiovascular and noncardiovascular events were registered for 148 months. When adjusted for age, sex, 24-hour mean blood pressure, and other risk factors, there was no relationship between the risk of death and 24-hour, day, and night blood pressure SDs. In contrast, the adjusted risk of cardiovascular death was inversely related to day-night diastolic BP difference (beta coefficient = -0.040; P < 0.02) and showed a significant positive relationship with residual diastolic blood pressure variability (beta coefficient = 0.175; P < 0.002). Twenty-four-hour mean blood pressure attenuation of nocturnal hypotension and erratic diastolic blood pressure variability all independently predicted the mortality risk, with the erratic variability being the most important factor. Our data show that the relationship of blood pressure to prognosis is complex and that phenomena other than 24-hour mean values are involved. They also provide the first evidence that short-term erratic components of blood pressure variability play a prognostic role, with their increase being accompanied by an increased cardiovascular risk.