Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks
Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks
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DOI：
10.1093/eurheartj/ehx760
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发表时间：
2018-06-21
影响因子：
39.3
通讯作者：
Berge, Eivind
中科院分区：
文献类型：
--
作者：
Mehlum, Maria H.;Liestol, Knut;Berge, Eivind
血压变异性与心血管事件的风险增加有关，特别是在高危患者中。我们评估是否变异与心血管事件和死亡的高血压患者在不同的风险levels.Methods和结果的风险增加缬沙坦抗高血压长期使用评估试验是一个随机对照试验缬沙坦与缬沙坦在高血压患者和不同的心血管事件的风险，平均为4.2年。我们计算了≥ 3次访视且前6个月内无事件的患者从6个月起访视的平均收缩压的标准差（SD）。我们使用考克斯回归分析比较了访视间血压变异性最高和最低五分位数的心血管事件风险。对于死亡分析，将变异性作为连续变量进行分析。在纳入的13803例患者中，1557例（11.3%）发生心血管事件，1089例（7.9%）死亡。SD最高五分位数的患者发生心血管事件的风险增加[风险比（HR）2.1，95%置信区间（95%CI）1.7-2.4; P < 0.0001]，收缩压SD增加5 mmHg与死亡风险增加10%相关（HR 1.10，95% CI 1.041.17; P = 0.002）。相关性较强的年轻患者和患者与塔收缩压，和不同的基线风险的患者之间相似，除了较高的死亡风险之间的患者与已建立的心血管diseases.Conclusion较高的访视收缩压变异性与高血压患者的心血管事件的风险增加，无论基线的心血管事件的风险。在年轻患者和平均收缩压较低的患者中，相关性更强。
Aims Blood pressure variability is associated with increased risk of cardiovascular events, particularly in high-risk patients. We assessed if variability was associated with increased risk of cardiovascular events and death in hypertensive patients at different risk levels.Methods and results The Valsartan Antihypertensive Long-term Use Evaluation trial was a randomized controlled trial of valsartan vs. amlodipine in patients with hypertension and different risks of cardiovascular events, followed for a mean of 4.2 years. We calculated standard deviation (SD) of mean systolic blood pressure from visits from 6 months onward in patients with >= 3 visits and no events during the first 6 months. We compared the risk of cardiovascular events in the highest and lowest quintile of visit-to-visit blood pressure variability, using Cox regression. For analysis of death, variability was analysed as a continuous variable. Of 13 803 patients included, 1557 (11.3%) had a cardiovascular event and 1089 (7.9%) died. Patients in the highest quintile of SD had an increased risk of cardiovascular events [hazard ratio (HR) 2.1, 95% confidence interval (95% CI) 1.7-2.4; P < 0.0001], and a 5 mmHg increase in SD of systolic blood pressure was associated with a 10% increase in the risk of death (HR 1.10, 95% CI 1.041.17; P = 0.002). Associations were stronger among younger patients and patients with tower systolic blood pressure, and similar between patients with different baseline risks, except for higher risk of death among patients with established cardiovascular disease.Conclusion Higher visit-to-visit systolic blood pressure variability is associated with increased risk of cardiovascular events in patients with hypertension, irrespective of baseline risk of cardiovascular events. Associations were stronger in younger patients and in those with lower mean systolic blood pressure.