Home blood pressure variability as cardiovascular risk factor in the population of Ohasama.
Home blood pressure variability as cardiovascular risk factor in the population of Ohasama.
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DOI：
10.1161/hypertensionaha.111.00138
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发表时间：
2013-01
期刊：
影响因子：
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通讯作者：
Imai Y
中科院分区：
文献类型：
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作者：
Asayama K;Kikuya M;Schutte R;Thijs L;Hosaka M;Satoh M;Hara A;Obara T;Inoue R;Metoki H;Hirose T;Ohkubo T;Staessen JA;Imai Y
基于诊室测量的血压变异性可预测选定患者的结局。我们探讨了新的血压变异性指数是否来自自我测量的家庭血压预测结果在一般人群中。我们监测2421 Ohasama居民（岩手县，日本）的死亡率和中风。在入组时（1988-1995），参与者（平均年龄，58.6岁; 60.9%的女性; 27.1%的治疗）在家中使用血压测量装置测量血压。在多变量校正的考克斯模型中，我们评估了受试者内平均收缩压（SBP）的独立预测值和相应的变异性，这些变异性是通过独立于平均值的变异性、最大和最小血压之间的差异以及平均真实的变异性估计的。在12.0年（中位数）的时间里，412名参与者死亡，139人死于心血管原因，223人中风。在包括早晨SBP的模型中，变异性独立于平均值和平均真实的变异性（中位数，26个读数）预测所有参与者的总死亡率和心血管死亡率（P≤0.044）;变异性独立于治疗组的平均预测心血管死亡率（P=0.014），但未治疗（P=0.23）的参与者;早晨最高和最低血压不能预测任何终点（P≥0.085）。在已经包括夜间SBP的模型中，只有变异性独立于所有受试者和未治疗受试者的平均预测心血管死亡率（P≤0.046）。R2统计量是通过将血压变异性添加到已经包括SBP和协变量的模型中来解释的增量风险的度量，范围从<0.01%到0.88%。在一般人群中，来自家庭血压的血压变异性的新指标并不能递增地预测超过平均SBP的结果。
Blood pressure variability based on office measurement predicts outcome in selected patients. We explored whether novel indices of blood pressure variability derived from the self-measured home blood pressure predicted outcome in a general population. We monitored mortality and stroke in 2421 Ohasama residents (Iwate Prefecture, Japan). At enrollment (1988–1995), participants (mean age, 58.6 years; 60.9% women; 27.1% treated) measured their blood pressure at home, using an oscillometric device. In multivariable-adjusted Cox models, we assessed the independent predictive value of the within-subject mean systolic blood pressure (SBP) and corresponding variability as estimated by variability independent of the mean, difference between maximum and minimum blood pressure, and average real variability. Over 12.0 years (median), 412 participants died, 139 of cardiovascular causes, and 223 had a stroke. In models including morning SBP, variability independent of the mean and average real variability (median, 26 readings) predicted total and cardiovascular mortality in all of the participants (P≤0.044); variability independent of the mean predicted cardiovascular mortality in treated (P=0.014) but not in untreated (P=0.23) participants; and morning maximum and minimum blood pressure did not predict any end point (P≥0.085). In models already including evening SBP, only variability independent of the mean predicted cardiovascular mortality in all and in untreated participants (P≤0.046). The R2 statistics, a measure for the incremental risk explained by adding blood pressure variability to models already including SBP and covariables, ranged from <0.01% to 0.88%. In a general population, new indices of blood pressure variability derived from home blood pressure did not incrementally predict outcome over and beyond mean SBP.