24-Hour Blood Pressure Variability Assessed by Average Real Variability: A Systematic Review and Meta-Analysis.
24-Hour Blood Pressure Variability Assessed by Average Real Variability: A Systematic Review and Meta-Analysis.
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DOI：
10.1161/jaha.117.006895
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发表时间：
2017-10-19
影响因子：
5.4
通讯作者：
Maestre GE
中科院分区：
文献类型：
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作者：
Mena LJ;Felix VG;Melgarejo JD;Maestre GE
尽管24小时血压（BP）变异性（BPV）可独立于绝对血压水平预测心血管结局，但在临床实践中并未定期评估。常规BPV评估的一个可能局限性是缺乏准确估计24小时BPV的标准化方法。我们进行了一项系统性综述，以评估报告的BPV指数的预测能力，以解决24小时BPV的适当量化问题，包括平均真实的变异性（ARV）指数。选择进行综述的研究是那些提供了来自Meta分析、纵向或横断面设计的成人24小时BPV数据的研究，并根据以下问题检查了BPV：（1）用于计算和评价ARV的方法;（2）使用无创动态血压监测确定的24小时BPV评估;（3）针对协变量调整的多变量分析，包括一些血压测量;（4）24小时BPV与亚临床器官损伤的相关性;（5）24小时BPV对靶器官损伤和心血管事件发生率的预测价值。在19项评估的研究中，17项报告了高抗逆转录病毒药物与亚临床器官损伤的存在和进展以及硬终点（如心血管事件）的发生率之间的显著相关性。在所有这些情况下，ARV仍然是一个显着的独立预测因子（P<0.05）调整后的血压和其他临床因素。此外，收缩压升高的ARV与所有心血管事件的风险相关（风险比，1.18; 95%置信区间，1.09-1.27）。只有2项横断面研究没有发现高抗逆转录病毒药物是一个显著的风险因素。目前的证据表明，ARV指数为24小时动态血压监测提供了重要的预后信息，是研究BPV临床价值的有用方法。
Although 24‐hour blood pressure (BP) variability (BPV) is predictive of cardiovascular outcomes independent of absolute BP levels, it is not regularly assessed in clinical practice. One possible limitation to routine BPV assessment is the lack of standardized methods for accurately estimating 24‐hour BPV. We conducted a systematic review to assess the predictive power of reported BPV indexes to address appropriate quantification of 24‐hour BPV, including the average real variability (ARV) index. Studies chosen for review were those that presented data for 24‐hour BPV in adults from meta‐analysis, longitudinal or cross‐sectional design, and examined BPV in terms of the following issues: (1) methods used to calculate and evaluate ARV; (2) assessment of 24‐hour BPV determined using noninvasive ambulatory BP monitoring; (3) multivariate analysis adjusted for covariates, including some measure of BP; (4) association of 24‐hour BPV with subclinical organ damage; and (5) the predictive value of 24‐hour BPV on target organ damage and rate of cardiovascular events. Of the 19 assessed studies, 17 reported significant associations between high ARV and the presence and progression of subclinical organ damage, as well as the incidence of hard end points, such as cardiovascular events. In all these cases, ARV remained a significant independent predictor (P<0.05) after adjustment for BP and other clinical factors. In addition, increased ARV in systolic BP was associated with risk of all cardiovascular events (hazard ratio, 1.18; 95% confidence interval, 1.09–1.27). Only 2 cross‐sectional studies did not find that high ARV was a significant risk factor. Current evidence suggests that ARV index adds significant prognostic information to 24‐hour ambulatory BP monitoring and is a useful approach for studying the clinical value of BPV.