Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension
Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension
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DOI：
10.1161/hypertensionaha.107.100727
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发表时间：
2008-01-01
期刊：
影响因子：
8.3
通讯作者：
De Bacquer, Dirk A.
中科院分区：
文献类型：
--
作者：
Fagard, Robert H.;Celis, Hilde;De Bacquer, Dirk A.
我们的目的是评估夜间和日间动态血压的预后意义，以及它们对基线时无重大心血管疾病的高血压患者的死亡率和病因特异性心血管事件的比率。我们对在欧洲进行的4项前瞻性研究的3468例患者的个体数据进行了荟萃分析。受试者的平均年龄为61 ± 13岁，45%为男性，13.7%吸烟，8.4%患有糖尿病，61%在动态血压监测时正在接受抗高血压治疗。办公室、日间和夜间血压平均值分别为159 +/- 20/ 91 +/- 12、143 +/- 17/87 +/- 12和130 +/- 18/75 +/- 12 mm Hg。总随访时间为23164患者年。我们使用多变量考克斯回归分析来评估与1个标准差高血压相关的风险比。日间和夜间收缩压预测全因和心血管死亡率、冠心病和中风，独立于诊室血压和混杂变量。当这些血压同时输入模型时，夜间血压预测了所有结果，而白天血压并没有增加夜间血压的预测精度。适当的相互作用项表明，结果在男性和女性，年轻和老年患者，治疗和未治疗的患者中相似。收缩压昼夜比预测所有结局，仅在校正24小时血压后对全因死亡率持续存在。总之，夜间血压通常比白天血压更能预测高血压患者的预后，即使在校正24小时血压后，夜-日血压比也能预测死亡率。
Our aim was to assess the prognostic significance of nighttime and daytime ambulatory blood pressure and their ratio for mortality and cause-specific cardiovascular events in hypertensive patients without major cardiovascular disease at baseline. We performed a meta-analysis on individual data of 3468 patients from 4 prospective studies performed in Europe. Age of the subjects averaged 61 +/- 13 years, 45% were men, 13.7% smoked, 8.4% had diabetes, and 61% were under antihypertensive treatment at the time of ambulatory blood pressure monitoring. Office, daytime, and nighttime blood pressure averaged 159 +/- 20/ 91 +/- 12, 143 +/- 17/87 +/- 12, and 130 +/- 18/75 +/- 12 mm Hg. Total follow-up amounted to 23 164 patient-years. We used multivariable Cox regression analysis to assess the hazard ratios associated with 1 standard deviation higher blood pressure. Daytime and nighttime systolic blood pressure predicted all-cause and cardiovascular mortality, coronary heart disease, and stroke, independently from office blood pressure and confounding variables. When these blood pressures were entered simultaneously into the models, nighttime blood pressure predicted all outcomes, whereas daytime blood pressure did not add prognostic precision to nighttime pressure. Appropriate interaction terms indicated that the results were similar in men and women, in younger and older patients, and in treated and untreated patients The systolic night-day blood pressure ratio predicted all outcomes, which only persisted for all-cause mortality after adjustment for 24-hour blood pressure. In conclusion, nighttime blood pressure is in general a better predictor of outcome than daytime pressure in hypertensive patients, and the night-day blood pressure ratio predicts mortality, even after adjustment for 24-hour blood pressure.