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门诊和动态血压测量与死亡率之间的关系
Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality


José R. Banegas ... 心脑血管疾病 • 2018.04.19
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摘要


背景

动态血压对预后影响的证据主要来自人群研究和少数相对较小型的临床研究。本研究在一个大型初级诊疗患者队列中分析了门诊测量的血压(门诊血压)和24小时动态血压与全因死亡率及心血管死亡率之间的关联。

 

方法

本研究的分析数据来源于一个基于登记研究的多中心、全国性队列,其中包括2004~2014年在西班牙招募的63,910名成人。门诊和24小时动态血压数据被归类如下:持续性高血压(门诊血压和24小时动态血压均升高)、“白大衣”高血压(门诊血压升高,24小时动态血压正常)、隐匿性高血压(门诊血压正常,24小时动态血压升高)和正常血压(门诊和24小时动态血压均正常)。数据分析采用Cox回归模型并校正了门诊和24小时动态血压以及混杂因素。

 

结果

在中位4.7年随访期间,3,808例患者死亡,其中1,295例死于心血管病因。在纳入24小时和门诊血压的模型中,24小时收缩压与全因死亡率的相关性(风险比,血压每增加1 SD为1.58;95%置信区间[CI],1.56~1.60,校正门诊血压后)比门诊收缩压与全因死亡率的相关性(风险比,1.02;95% CI,1.00~1.04,校正24小时血压后)更强。就夜间动态收缩压和日间动态收缩压而言,血压每增加1 SD所对应的风险比分别为1.55(95% CI,1.53~1.57,校正门诊和日间血压后)和1.54(95% CI,1.52~1.56,校正门诊和夜间血压后)。这些关系在不同年龄、性别及肥胖、糖尿病、心血管疾病和抗高血压治疗状况的亚组中均是一致的。与持续性高血压(风险比,1.80;95% CI,1.41~2.31)或“白大衣”高血压(风险比,1.79;95% CI,1.38~2.32)相比,隐匿性高血压与全因死亡率的相关性更强(风险比,2.83;95% CI,2.12~3.79)。心血管死亡率的结果与全因死亡率的结果相似。

 

结论

与门诊血压测量相比,动态血压测量是全因和心血管死亡率的更强预测指标。“白大衣”高血压并非良性,隐匿性高血压比持续性高血压的死亡风险更高(由西班牙高血压学会[Spanish Society of Hypertension]等资助)。





作者信息

José R. Banegas, M.D., Luis M. Ruilope, M.D., Alejandro de la Sierra, M.D., Ernest Vinyoles, M.D., Manuel Gorostidi, M.D., Juan J. de la Cruz, M.Sc., Gema Ruiz-Hurtado, Ph.D., Julián Segura, M.D., Fernando Rodríguez-Artalejo, M.D., and Bryan Williams, M.D.
From the Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Instituto de Investigación Hospital Universitario La Paz (IdiPAZ) and Centro de Investigación Biomédica en Red (CIBER) of Epidemiology and Public Health (J.R.B., L.M.R., J.J.C., F.R.-A.), the Hypertension Unit, Department of Nephrology, and Cardiorenal Translational Research Laboratory, Institute of Research, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (L.M.R., G.R.-H., J.S.), the School of Doctoral Studies and Research, Universidad Europea de Madrid (L.M.R.), and Madrid Institute for Advanced Studies Food Institute, Campus de Excelencia Internacional de la Universidad Autónoma de Madrid y Consejo Superior de Investigaciones Científicas (F.R.-A.), Madrid, the Department of Internal Medicine, Hospital Mutua Terrassa (A.S.), and La Mina Primary Care Center (E.V.), University of Barcelona, Barcelona, and the Nephrology Service, Hospital Universitario Central de Asturias, Red de Investigación Renal, Oviedo (M.G.) — all in Spain; and University College London (UCL) Institute of Cardiovascular Science and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London (B.W.). Address reprint requests to Dr. Banegas at the Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ–CIBER of Epidemiology and Public Health, Avda. Arzobispo Morcillo 2, 28029 Madrid, Spain, or at joseramon.banegas@uam.es.

 

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