Blood Pressure Response to Patterns of Weather Fluctuations and Effect on Mortality
Blood Pressure Response to Patterns of Weather Fluctuations and Effect on Mortality
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DOI：
10.1161/hypertensionaha.111.00686
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发表时间：
2013-07-01
期刊：
影响因子：
8.3
通讯作者：
Padmanabhan, Sandosh
中科院分区：
文献类型：
--
作者：
Aubiniere-Robb, Louise;Jeemon, Panniyammakal;Padmanabhan, Sandosh
很少有研究关注个体血压对天气条件的纵向反应。没有数据表明对天气变化的具体反应会对生存产生影响。我们分析了格拉斯哥血压诊所 16,010 名高血压患者的超过 169,000 次就诊次数。每次诊所就诊都映射到苏格兰西部平均每月天气（温度、阳光、降雨量）数据。计算两次连续就诊之间的血压变化百分比，其中天气在每个天气参数的 2 个极端四分位数（Q(1)-Q(4) 或 Q(4)-Q(1)）之间交替或保持在同一四分位数（Q(n)-Q(n)）。根据 Q(1)-Q(4) 或 Q(4)-Q(1) 中的血压反应是否与 Q(n)-Q(n) 一致或不一致，将受试者分为 2 组。广义估计方程和 Cox 比例风险模型分别用于模拟对纵向血压和死亡率的影响。 Q(n)-Q(n) 显示血压持续平均下降 2%，而 Q(4)-Q(1) 显示收缩压和舒张压分别平均上升 2.1% 和 1.6%。然而，Q(1)-Q(4)并未显示出血压的显着变化。与温度不敏感受试者相比，温度敏感受试者的死亡率显着较高（1.35 [95% 置信区间，1.06-1.71]；P=0.01），随访收缩压也较高（1.85 [95% 置信区间，0.24-3.46]；P=0.02）。血压对温度的反应可能是决定长期血压变异性的潜在机制之一。了解患者血压对天气的反应有助于减少不必要的抗高血压治疗调整，而这反过来又可能增加血压变异性，从而增加风险。
Very few studies have looked at longitudinal intraindividual blood pressure responses to weather conditions. There are no data to suggest that specific response to changes in weather will have an impact on survival. We analyzed >169 000 clinic visits of 16 010 Glasgow Blood Pressure Clinic patients with hypertension. Each clinic visit was mapped to the mean West of Scotland monthly weather (temperature, sunshine, rainfall) data. Percentage change in blood pressure was calculated between pairs of consecutive clinic visits, where the weather alternated between 2 extreme quartiles (Q(1)-Q(4) or Q(4)-Q(1)) or remained in the same quartile (Q(n)-Q(n)) of each weather parameter. Subjects were also categorized into 2 groups depending on whether their blood pressure response in Q(1)-Q(4) or Q(4)-Q(1) were concordant or discordant to Q(n)-Q(n). Generalized estimating equations and Cox proportional hazards model were used to model the effect on longitudinal blood pressure and mortality, respectively. Q(n)-Q(n) showed a mean 2% drop in blood pressure consistently, whereas Q(4)-Q(1) showed a mean 2.1% and 1.6% rise in systolic and diastolic blood pressure, respectively. However, Q(1)-Q(4) did not show significant changes in blood pressure. Temperature-sensitive subjects had significantly higher mortality (1.35 [95% confidence interval, 1.06-1.71]; P=0.01) and higher follow-up systolic blood pressure (1.85 [95% confidence interval, 0.24-3.46]; P=0.02) compared with temperature-nonsensitive subjects. Blood pressure response to temperature may be one of the underlying mechanisms that determine long-term blood pressure variability. Knowing a patient's blood pressure response to weather can help reduce unnecessary antihypertensive treatment modification, which may in turn increase blood pressure variability and, thus, risk.