Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial
Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial
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DOI：
10.1093/eurheartj/ehx250
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发表时间：
2017-10-01
影响因子：
39.3
通讯作者：
Steg, Philippe Gabriel
中科院分区：
文献类型：
--
作者：
Vidal-Petiot, Emmanuelle;Stebbins, Amanda;Steg, Philippe Gabriel
方法和结果稳定性试验中15 828例患者(已确诊的冠心病患者中达拉普拉地布与安慰剂对照)，在随机分组后的第一年内，用5个测量值(基线和1、3、6、12个月)的收缩压标准差(SD)、舒张压标准差(SD)、最大血压标准差(SD)、最大血压标准差(SD)和最小血压标准差(SD)来评估血压变异性。研究第一年的平均血压(SD)为131.0(13.7)毫米汞柱，高于78.38.3毫米汞柱。平均来访标准差(SD)：收缩压为9.8(4.8)mm Hg，舒张压为6.3(3.0)mm Hg。在随后2.6年的中位数随访中，1010名患者达到了主要终点，即心血管死亡、心肌梗死或中风的综合时间。在校正了研究第一年的平均血压、基线血管疾病、治疗、肾功能和心血管危险因素的COX回归模型中，主要终点与收缩压的SD(最高与最低三分位数的风险比，1.3，95%可信区间1.10-1.53，P=0.007)和舒张压的标准偏差(最高与最低三分位数的风险比，1.38，95%可信区间1.18-1.62，P<；0.001)相关。血压的峰值和低谷也与不良事件独立相关。结论在稳定型冠心病患者中，无论是平均血压还是平均血压，较高的就诊/就诊变异性都是心血管事件风险增加的有力预测因素。
Aims To study the relation between visit-to-visit variability of blood pressure (BP) and cardiovascular risk in patients with stable coronary heart disease.Methods and results In 15 828 patients from the STABILITY trial (darapladib vs. placebo in patients with established coronary heart disease), BP variability was assessed by the standard deviation (SD) of systolic BP, the SD of diastolic BP, maximum BP, and minimum BP, from 5 measurements (baseline and months 1, 3, 6, and 12) during the first year after randomisation. Mean (SD) average BP during the first year of study was 131.0 (13.7) mmHg over 78.3 (8.3) mmHg. Mean (SD) of the visit-to-visit SD was 9.8 (4.8) mmHg for systolic and 6.3 (3.0) mmHg for diastolic BP. During the subsequent median follow-up of 2.6 years, 1010 patients met the primary endpoint, a composite of time to cardiovascular death, myocardial infarction, or stroke. In Cox regression models adjusted for average BP during first year of study, baseline vascular disease, treatment, renal function and cardiovascular risk factors, the primary endpoint was associated with SD of systolic BP (hazard ratio for highest vs. lowest tertile, 1.30, 95% CI 1.10-1.53, P = 0.007), and with SD of diastolic BP (hazard ratio for highest vs. lowest tertile, 1.38, 95% CI 1.18-1.62, P < 0.001). Peaks and troughs in BP were also independently associated with adverse events.Conclusion In patients with stable coronary heart disease, higher visit-to-visit variabilities of both systolic and diastolic BP are strong predictors of increased risk of cardiovascular events, independently of mean BP.