Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis.
Visit-to-visit systolic blood pressure variability and outcomes in hemodialysis.
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DOI：
10.1038/jhh.2013.49
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发表时间：
2014-01
影响因子：
2.7
通讯作者：
中科院分区：
文献类型：
--
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访视间血压变异（VTV-BPV）是一般人群心血管事件和死亡的独立风险因素。我们试图确定VTV-BPV与血液透析患者结局的相关性，使用来自美国国立卫生研究院赞助的随机试验（HEMO研究）的数据。我们使用收缩压（SBP）的变异系数（CV）和平均真实的变异性（ARV）作为VTV-BPV的度量。1846例随机化受试者中有1844例至少接受了3次SBP测量访视，并被纳入分析。中位随访时间为2.5年（四分位距[IQR] 1.3 - 4.3年），在此期间有869例任何原因的死亡和408例（裁定）心血管死亡。平均透析前SBP CV为9.9% ± 4.6%。在未调整的模型中，我们发现VTV-BPV每增加10%，任何原因导致的死亡风险增加31%。这种关联在多变量调整后减弱，但仍具有统计学意义。同样，我们发现VTV-BPV每增加10%，心血管死亡风险增加28%，这在完全校正的模型中减弱且不再具有统计学意义。VTV-BPV、死亡和心血管死亡之间的相关性通过基线SBP进行修改。在维持性血液透析患者的多样化、透析良好队列中，使用透析前SBP变异性指标评估的VTV-BPV与全因死亡风险较高和心血管死亡风险较高的趋势相关，尤其是在基线SBP较低的患者中。
Visit-to-visit blood pressure variation (VTV-BPV) is an independent risk factor for cardiovascular events and death in the general population. We sought to determine the association of VTV-BPV with outcomes in patients on hemodialysis, using data from a National Institutes of Health-sponsored randomized trial (the HEMO Study). We used the coefficient of variation (CV) and the average real variability (ARV) in systolic blood pressure (SBP) as metrics of VTV-BPV. 1844 of 1846 randomized subjects had at least three visits with SBP measurements and were included in the analysis. Median follow-up was 2.5 years (interquartile range [IQR] 1.3 to 4.3 years), during which time there were 869 deaths from any cause and 408 (adjudicated) cardiovascular deaths. The mean pre-dialysis SBP CV was 9.9% ± 4.6%. In unadjusted models, we found a 31% higher risk of death from any cause per 10% increase in VTV-BPV. This association was attenuated after multivariable adjustment but remained statistically significant. Similarly, we found a 28% higher risk of cardiovascular death per 10% increase in VTV-BPV, which was attenuated and no longer statistically significant in fully adjusted models. The associations among VTV-BPV, death and cardiovascular death were modified by baseline SBP. In a diverse, well-dialyzed cohort of patients on maintenance hemodialysis, VTV-BPV, assessed using metrics of variability in pre-dialysis SBP, was associated with a higher risk of all-cause mortality and a trend towards higher risk of cardiovascular mortality, particularly in patients with a lower baseline SBP.
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DOI：
10.1161/hypertensionaha.111.00138
发表时间：
2013-01
期刊：
Hypertension (Dallas, Tex. : 1979)
影响因子：
--
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
通讯作者：
Imai Y
影响因子：
3.2
作者：
Brueren, MM;vanLimpt, P;vanRee, JW
通讯作者：
vanRee, JW
影响因子：
2
作者：
DURRLEMAN, S;SIMON, R
通讯作者：
SIMON, R
影响因子：
19.6
作者：
Miskulin, DC;Athienites, NV;Levey, AS
通讯作者：
Levey, AS
DOI：
10.1111/jch.12037
发表时间：
2013-02
期刊：
Journal of clinical hypertension (Greenwich, Conn.)
影响因子：
--
作者：
Muntner P;Levitan EB;Joyce C;Holt E;Mann D;Oparil S;Krousel-Wood M
通讯作者：
Krousel-Wood M