Assessment and management of blood-pressure variability
Assessment and management of blood-pressure variability
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DOI：
10.1038/nrcardio.2014.44
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发表时间：
2014-06
影响因子：
49.6
通讯作者：
G. Parati;J. Ochoa;C. Lombardi;G. Bilo
中科院分区：
文献类型：
--
作者：
G. Parati;J. Ochoa;C. Lombardi;G. Bilo
血压（BP）的特点是在24小时内发生显著的短期波动（心跳到心跳，分钟到分钟，小时到小时和昼夜变化），并且在更长的时间内（天，周，月，季节甚至年）发生长期波动。而不是代表“背景噪音”或随机发生的现象，这些变化已被证明是外在的环境和行为因素和内在的心血管调节机制之间的复杂相互作用的结果。虽然高血压的心血管不良后果在很大程度上取决于绝对血压值，但观察性研究和临床试验数据的事后分析表明，这些结果也可能取决于血压变异性（BPV）的增加。短期和长期BPV增加与心脏、血管和肾脏损害的发生、进展和严重程度相关，并与心血管事件和死亡率的风险增加相关。特别令人感兴趣的是对高血压的大型干预试验的随访后分析结果，显示患者内访视间BPV对心血管发病率和死亡率有很强的预测作用。这一结果引发了关于抗高血压治疗是否应不仅针对降低平均BP水平，还应稳定BPV的讨论，目的是随着时间的推移实现一致的BP控制，这可能有利于心血管保护。
Blood pressure (BP) is characterized by marked short-term fluctuations occurring within a 24 h period (beat-to-beat, minute-to-minute, hour-to-hour, and day-to-night changes) and also by long-term fluctuations occurring over more-prolonged periods of time (days, weeks, months, seasons, and even years). Rather than representing 'background noise' or a randomly occurring phenomenon, these variations have been shown to be the result of complex interactions between extrinsic environmental and behavioural factors and intrinsic cardiovascular regulatory mechanisms. Although the adverse cardiovascular consequences of hypertension largely depend on absolute BP values, evidence from observational studies andpost-hocanalyses of data from clinical trials have indicated that these outcomes might also depend on increased BP variability (BPV). Increased short-term and long-term BPV are associated with the development, progression, and severity of cardiac, vascular, and renal damage and with an increased risk of cardiovascular events and mortality. Of particular interest are the findings frompost-hocanalyses of large intervention trials in hypertension, showing that within-patient visit-to-visit BPV is strongly prognostic for cardiovascular morbidity and mortality. This result has prompted discussion on whether antihypertensive treatment should be targeted not only towards reducing mean BP levels but also to stabilizing BPV with the aim of achieving consistent BP control over time, which might favour cardiovascular protection.