Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality - The Ohasama Study
Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality - The Ohasama Study
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DOI：
10.1161/01.hyp.0000152079.04553.2c
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发表时间：
2005-02-01
期刊：
影响因子：
8.3
通讯作者：
Imai, Y
中科院分区：
文献类型：
--
作者：
Kikuya, M;Ohkubo, T;Imai, Y
本研究的目的是阐明动态血压的长期预后意义。从日本农村社区的1332名年龄大于或等于40岁的受试者（872名女性和460名男性）中获得了动态血压值和临时血压值。然后随访14370患者年的生存率，并通过调整可能的混杂因素的考克斯风险模型进行分析。在10.8年的随访中，有72例心血管死亡。24小时收缩压与心血管死亡风险之间的关系在前5年呈U形，然后在其余10.8年的随访中变为J形。在对前2年的数据进行删失后，风险趋于平稳，直到10.8年随访期间24小时收缩压的第五个五分位数再次增加。对于24小时舒张压，J形关系保持不变，无论随访持续时间和删失。在10.8年的随访数据中，动态收缩压值对心血管死亡风险的预测能力始终高于偶然收缩压，而在前2年删失后，这种关系变得更加明显。当夜间和日间收缩压值同时纳入同一考克斯模型时，只有夜间血压显著预测10.8年随访数据的心血管死亡风险。我们的结论是，动态收缩压和心血管死亡率之间的关系不是U形或J形，夜间血压比白天血压有更好的预后价值。
The objective of this study was to elucidate the long-term prognostic significance of ambulatory blood pressure. Ambulatory and casual blood pressure values were obtained from 1332 subjects ( 872 women and 460 men) aged greater than or equal to40 years from the general population of a rural Japanese community. Survival was then followed for 14 370 patient years and analyzed by a Cox hazard model adjusted for possible confounding factors. There were 72 cardiovascular deaths during the 10.8-year follow-up. The relationship between 24-hour systolic blood pressure and the cardiovascular mortality risk was U-shaped in the first 5 years, then changed to J-shaped over the rest of the 10.8-year follow-up. After censoring the first 2 years of data, the risk flattened until it again increased for the fifth quintile of 24-hour systolic blood pressure for the 10.8-year follow-up period. For 24-hour diastolic blood pressure, the J-shaped relationship remained unchanged, regardless of follow-up duration and censoring. Ambulatory systolic blood pressure values consistently showed stronger predictive power for cardiovascular mortality risk than did casual systolic blood pressure in the 10.8-year follow-up data, whereas such relationships became more marked after censoring the first 2 years. When nighttime and daytime systolic blood pressure values were simultaneously included in the same Cox model, only nighttime blood pressure significantly predicted the cardiovascular mortality risk for the 10.8-year follow-up data. We conclude that the relationship between ambulatory systolic blood pressure and cardiovascular mortality is not U-shaped or J-shaped, and that nighttime blood pressure has better prognostic value than daytime blood pressure.