Hypertension:家庭血压变异预测转归无显著优势

　　研究表明，在普通人群中，由家庭血压衍生的血压变异性新指数在转归并未较平均收缩压增加转归预测价值。论文于2012年11月19日在线发表于《高血压》（Hypertension）。

　　此项研究共纳入2421例受试者（平均年龄58.6岁，女性60.9%，经治者27.1%）。入组时受试者通过示波装置测定家庭血压。利用多变量校正Cox模型评估平均收缩压和相应变异性的独立预测价值。上述变异性通过独立于平均血压、最高与最低血压差异和平均真正变异的变异性估算得出。

　　结果显示，在超过中位12年随访期间，412例受试者死亡（139例为心血管性死亡），并有223例发生卒中。在包括晨起收缩压的模型中，独立于平均血压和平均真正变异的变异性可在所有受试者中预测总体和心血管性死亡（P≤0.044）；独立于平均血压的变异性可在经治者中预测心血管性死亡，但在未治者中则无法预测；晨起最高和最低血压无法预测任何终点。在已包括夜间收缩压的模型中，仅独立于平均血压的变异性可在所有和未治受试者中预测心血管性死亡。

Home Blood Pressure Variability as Cardiovascular Risk Factor in the Population of Ohasama

Abstract

Blood pressure variability based on office measurement predicts outcome in selected patients. We explored whether novel indices of blood pressure variability derived from the self-measured home blood pressure predicted outcome in a general population. We monitored mortality and stroke in 2421 Ohasama residents (Iwate Prefecture, Japan). At enrollment (1988–1995), participants (mean age, 58.6 years; 60.9% women; 27.1% treated) measured their blood pressure at home, using an oscillometric device. In multivariable-adjusted Cox models, we assessed the independent predictive value of the within-subject mean systolic blood pressure (SBP) and corresponding variability as estimated by variability independent of the mean, difference between maximum and minimum blood pressure, and average real variability. Over 12.0 years (median), 412 participants died, 139 of cardiovascular causes, and 223 had a stroke. In models including morning SBP, variability independent of the mean and average real variability (median, 26 readings) predicted total and cardiovascular mortality in all of the participants (P≤0.044); variability independent of the mean predicted cardiovascular mortality in treated (P=0.014) but not in untreated (P=0.23) participants; and morning maximum and minimum blood pressure did not predict any end point (P≥0.085). In models already including evening SBP, only variability independent of the mean predicted cardiovascular mortality in all and in untreated participants (P≤0.046). The R2 statistics, a measure for the incremental risk explained by adding blood pressure variability to models already including SBP and covariables, ranged from <0.01% to 0.88%. In a general population, new indices of blood pressure variability derived from home blood pressure did not incrementally predict outcome over and beyond mean SBP.