Blood Pressure Variability and the Risk of All-Cause Mortality, Incident Myocardial Infarction, and Incident Stroke in the Cardiovascular Health Study
Blood Pressure Variability and the Risk of All-Cause Mortality, Incident Myocardial Infarction, and Incident Stroke in the Cardiovascular Health Study
复制标题
DOI：
10.1093/ajh/hpt092
复制
发表时间：
2013-10-01
影响因子：
3.2
通讯作者：
Longstreth, W. T., Jr.
中科院分区：
文献类型：
--
作者：
Suchy-Dicey, Astrid M.;Wallace, Erin R.;Longstreth, W. T., Jr.
背景：最近的报告将就诊间收缩压(SBP)的变异性与死亡率和卒中风险联系在一起，与平均SBP水平的影响无关。本研究旨在评估SBP的变异性是否与全因死亡率、发生的心肌梗死(MI)和发生的卒中有关，而与平均SBP或SBP水平随时间的变化无关。方法心血管健康研究是对老年人血管危险因素和疾病的纵向队列研究。参加前5次年度就诊且在第5次就诊前没有经历任何活动的参与者符合条件(n=3,852)。初步分析仅限于前5次就诊期间未服用降压药的参与者(n=1,642)。使用每个参与者的5次血压测量来定义个体内的SBP变量。COX比例风险模型估计了个体内SBP变异性每增加一次调整后的危险比(HR)，并根据个体内SBP的平均值和随时间的变化进行了调整。结果平均随访9.9年，有844例死亡、203例失误和195例中风。个体内SBP变异性与死亡风险(HR=1.13；95%可信区间=1.05-1.21)和发生心肌梗死风险(HR=1.20；95%CI=1.06-1.36)显著相关，与调整因素的影响无关。个体内SBP变异性与卒中风险无关(HR=1.03；95%CI=0.89-1.21)。结论长期就诊间SBP变异性独立地与较高的后续死亡率和MI风险相关，但与卒中无关。需要更多的研究来确定血压变异性与心血管风险的关系及其临床意义。
BACKGROUNDRecent reports have linked variability in visit-to-visit systolic blood pressure (SBP) to risk of mortality and stroke, independent of the effect of mean SBP level. This study aimed to evaluate whether variability in SBP is associated with all-cause mortality, incident myocardial infarction (MI), and incident stroke, independent of mean SBP or trends in SBP levels over time.METHODSThe Cardiovascular Health Study is a longitudinal cohort study of vascular risk factors and disease in the elderly. Participants who attended their first 5 annual clinic visits and experienced no event before the 5th visit were eligible (n = 3,852). Primary analyses were restricted to participants not using antihypertensive medications throughout the first 5 clinic visits (n = 1,642). Intraindividual SBP variables were defined using each participant's 5-visit blood pressure measures. Cox proportional hazards models estimated adjusted hazard ratios (HRs) per SD increase in intraindividual SBP variability, adjusted for intraindividual SBP mean and change over time.RESULTSOver a mean follow-up of 9.9 years, there were 844 deaths, 203 MIs, and 195 strokes. Intraindividual SBP variability was significantly associated with increased risk of mortality (HR = 1.13; 95% confidence interval (CI) = 1.05-1.21) and of incident MI (HR = 1.20; 95% CI = 1.06-1.36), independent of the effect from adjustment factors. Intraindividual SBP variability was not associated with risk of stroke (HR = 1.03; 95% CI = 0.89-1.21).CONCLUSIONSLong-term visit-to-visit SBP variability was independently associated with a higher risk of subsequent mortality and MI but not stroke. More research is needed to determine the relationship of BP variability with cardiovascular risk and the clinical implications.