Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension
Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension
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DOI：
10.1056/nejmoa022273
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发表时间：
2003-06-12
影响因子：
158.5
通讯作者：
O'Brien, E
中科院分区：
文献类型：
--
作者：
Clement, DL;De Buyzere, ML;O'Brien, E
背景资料：目前尚不确定高血压治疗患者24小时动态血压测量值是否能独立于医生办公室血压测量值和其他心血管危险因素预测心血管事件。方法：我们评估了1963例中位随访时间为12个月的患者中，治疗患者基线动态血压与随后心血管事件之间的关系。结果：我们记录了157例患者新发心血管事件。在校正年龄、性别、吸烟状况、有无糖尿病、血清胆固醇浓度、体重指数、使用或未使用降脂药物、有无心血管事件史以及在医生办公室测量的血压的考克斯比例风险模型中，24小时动态收缩压和舒张压均值较高是新发心血管事件的独立危险因素。与血压增加1-SD相关的心血管事件的校正相对危险度为1.34（95%置信区间，1.11 - 1.62）24小时动态收缩压，1.30（95%置信区间，1.08至1.58）为白天动态收缩压，1.27（95%置信区间，1.07至1.57）夜间动态收缩压。对于动态舒张压，与1-SD增量相关的心血管事件的相应相对风险为1.21（95%置信区间，1.01至1.46），1.24（95%置信区间，1.03至1.49）和1.18（95%置信区间，0.98 ~ 1.40）。结论：在接受治疗的高血压患者中，较高的动态收缩压或舒张压预测心血管事件，即使在校正了经典的危险因素，测量血压。
Background: It is uncertain whether ambulatory blood-pressure measurements recorded for 24 hours in patients with treated hypertension predict cardiovascular events independently of blood-pressure measurements obtained in the physician's office and other cardiovascular risk factors.Methods: We assessed the association between base-line ambulatory blood pressures in treated patients and subsequent cardiovascular events among 1963 patients with a median follow-up of 5 years (range, 1 to 66 months).Results: We documented new cardiovascular events in 157 patients. In a Cox proportional-hazards model with adjustment for age, sex, smoking status, presence or absence of diabetes mellitus, serum cholesterol concentration, body-mass index, use or nonuse of lipid-lowering drugs, and presence or absence of a history of cardiovascular events, as well as blood pressure measured at the physician's office, higher mean values for 24-hour ambulatory systolic and diastolic blood pressure were independent risk factors for new cardiovascular events. The adjusted relative risk of cardiovascular events associated with a 1-SD increment in blood pressure was 1.34 (95 percent confidence interval, 1.11 to 1.62) for 24-hour ambulatory systolic blood pressure, 1.30 (95 percent confidence interval, 1.08 to 1.58) for ambulatory systolic blood pressure during the daytime, and 1.27 (95 percent confidence interval, 1.07 to 1.57) for ambulatory systolic blood pressure during the nighttime. For ambulatory diastolic blood pressure, the corresponding relative risks of cardiovascular events associated with a 1-SD increment were 1.21 (95 percent confidence interval, 1.01 to 1.46), 1.24 (95 percent confidence interval, 1.03 to 1.49), and 1.18 (95 percent confidence interval, 0.98 to 1.40).Conclusions: In patients with treated hypertension, a higher ambulatory systolic or diastolic blood pressure predicts cardiovascular events even after adjustment for classic risk factors including office measurements of blood pressure.