Nighttime blood pressure dipping in young adults and coronary artery calcium 10-15 years later: the coronary artery risk development in young adults study.
Nighttime blood pressure dipping in young adults and coronary artery calcium 10-15 years later: the coronary artery risk development in young adults study.
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DOI：
10.1161/hypertensionaha.112.191536
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发表时间：
2012-06
期刊：
影响因子：
--
通讯作者：
Jacobs DR Jr
中科院分区：
文献类型：
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作者：
Viera AJ;Lin FC;Hinderliter AL;Shimbo D;Person SD;Pletcher MJ;Jacobs DR Jr
夜间血压（BP）下降可量化为夜间（睡眠）平均血压与白天（清醒）平均血压之比。蘸水比例为0.90的人被称为不蘸水者，不蘸水与心血管疾病事件有关。我们使用来自年轻人冠状动脉风险发展（CARDIA）研究的动态血压监测亚研究的数据，研究了年轻人夜间收缩期血压下降与10-15年后冠状动脉钙（CAC）存在之间的关系。239名受试者的夜间和日间读数及冠状动脉钙化测量均足够，收缩压下降比为0.72至1.24（平均0.88，标准差0.06），54名受试者（22.6%）在10至15年后出现CAC。与收缩压下降比在0.88到0.92之间（四分位数3）的患者相比，57名（23.9%）血压下降不明显或不存在（比率0.92到1.24，四分位数4）的患者存在CAC的未调整优势比为4.08 （95% CI 1.48-11.2）。60名受试者（25.1%）有更明显的下降（比值0.72至0.85，四分位数1）也有更大的CAC存在的几率（OR 4.76; 95% CI 1.76-12.9）。当模型作为一个连续预测因子时，收缩压下降率与未来CAC之间的u型关系是明显的，并且在多个潜在混杂因素调整后仍然存在（二次项p<0.001）。收缩压下降不足和夜间“过降”都可能与未来的亚临床冠状动脉粥样硬化有关。
Nighttime blood pressure (BP) dipping can be quantified as the ratio of mean nighttime (sleep) BP to mean daytime (awake) BP. People whose dipping ratio is 0.90 have been referred to as nondippers, and nondipping is associated with cardiovascular disease events. We examined the relationship between systolic nighttime BP dipping in young adults and presence of coronary artery calcium (CAC) 10-15 years later using data from the ambulatory BP monitoring substudy of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Among 239 participants with adequate measures of both nighttime and daytime readings and coronary artery calcium, the systolic BP dipping ratio ranged from 0.72 to 1.24 (mean 0.88, SD 0.06), and CAC was present 10 to 15 years later in 54 participants (22.6%). Compared to those whose systolic BP dipping ratio ranged from 0.88 to 0.92 (Quartile 3), the 57 participants (23.9%) with less pronounced or absent dipping (ratio 0.92 to 1.24, Quartile 4) had an unadjusted odds ratio of 4.08 (95% CI 1.48-11.2) for presence of CAC. The 60 participants (25.1%) with a more pronounced dipping (ratio 0.72 to 0.85, Quartile 1) also had greater odds for presence of CAC (OR 4.76; 95% CI 1.76-12.9). When modeled as a continuous predictor, a U-shaped relationship between systolic BP dipping ratio and future CAC was apparent, and persisted after adjustment for multiple potential confounders (p<0.001 for quadratic term). Both failure of systolic BP to dip sufficiently and “overdipping” during nighttime may be associated with future subclinical coronary atherosclerosis.