The value of ambulatory blood pressure in older adults: the Dublin outcome study
The value of ambulatory blood pressure in older adults: the Dublin outcome study
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DOI：
10.1093/ageing/afm193
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发表时间：
2008-03-01
期刊：
影响因子：
6.7
通讯作者：
McCormack, Patricia
中科院分区：
文献类型：
--
作者：
Burr, Marian L.;Dolan, Eamon;McCormack, Patricia
背景：在年轻成人中，动态血压（ABPM）似乎比临床测量的血压（BP）更准确地预测心血管结局。目的：本研究的目的是确定ABPM是否能独立于临床血压和其他心血管危险因素预测65岁及以上人群的总死亡率和心血管死亡率。方法：1144名65岁及以上的患者在一个血压诊所进行了24小时ABP测量和基线治疗后的临床测量。在平均6.7年的随访期间，有385人死亡（其中246人死于心血管疾病）。结果：在调整性别、年龄、危险指标和临床血压后，较高的ABPM平均值是心血管死亡率的独立预测因子。白天收缩压（SBP）每升高10mmhg的相对危险比为1.10 (1.06-1.18,P < 0.001)，夜间收缩压升高1.18 （1.11-1.25,P < 0.001）。白天舒张压（DBP）每升高5 mmhg的危险比为1.05 (1.00-1.10，P=NS)，夜间舒张压升高1.09 （1.04-1.14,P < 0.001）。在调整白天ABPM后，夜间ABPM的风险比仍然显著。结论：动态血压测量在预测老年人心血管疾病死亡率方面优于临床测量。夜间血压是该年龄组预后的最强预测因子。
Background: ambulatory blood pressure (ABPM) appears to be a more accurate predictor of cardiovascular outcome than blood pressure (BP) measured in the clinic setting in younger adults.Objectives: the purpose of this study was to determine if ABPM predicted total and cardiovascular mortality independently of clinic BP and other cardiovascular risk factors in those aged 65 years and over.Methods: one thousand one hundred and forty-four individuals aged 65 and over referred to a single BP clinic had 24-h ABP measurement and clinic measurement at baseline off treatment. There were 385 deaths (of which 246 were cardiovascular) during a mean follow-up period of 6.7 years.Results: with adjustment for gender, age, risk indices and also for clinic BP, a higher mean value of ABPM was an independent predictor of cardiovascular mortality. The relative hazard ratio for each 10-mmHg rise in systolic blood pressure (SBP) was 1.10 (1.06-1.18, P < 0.001) for daytime and 1.18 (1.11-1.25, P < 0.001) for night-time SBP. The hazard ratios for each 5-mmHg rise in diastolic blood pressure (DBP) were 1.05 (1.00-1.10, P=NS) for daytime and 1.09 (1.04-1.14, P < 0.001) for night-time diastolic pressure. The hazard ratios for night-time ABPM remained significant after adjustment for daytime ABPM.Conclusions: ambulatory measurement of BP is superior to clinic measurement in predicting cardiovascular mortality in elderly subjects. Night-time BP is the strongest predictor of outcome in this age group.