門診患者的血壓變異性常被忽略。近期，美國學者對血壓變異性與冠心病(CVD)和死亡的關係進行了一項前瞻性隊列研究。結果表明，較高的收縮壓變異性與CVD和死亡風險增加有關，未來應針對減少血壓變異性是否可以降低這種風險進行進一步的評估。相關論文7月29日在線發表於《內科學文獻》(Ann Intern Med)。
該研究為ALLHAT研究的事後分析，共納入25814例受試者。以入組後6個月至28個月期間7次隨訪獲得的收縮壓標準差(SD)定義為收縮壓變異性。對首個28個月隨訪期間無CVD事件的受試者進行持續的隨訪，直至ALLHAT研究結束。轉歸包括致死性冠心病(CHD)或非致死性心肌梗死(MI)、全因死亡、卒中和心力衰竭。
結果顯示，在隨訪期間，發生CHD或非致死性MI事件、死亡、卒中和心力衰竭數分別為1194例、1948例、606例和921例。經過多變量校正後(包括平均收縮壓)，收縮壓最高五分位數和最低五分位數患者相比，CHD或非致死性MI、全因死亡、卒中和心力衰竭的危險比分別為1.30、1.58、1.46和1.25。舒張壓變異性較高也與CVD事件和死亡有關。
參考文獻：Paul Muntner, et al. Ann Intern Med.Published online28July2015doi:10.7326/M14-2803
Visit-to-Visit Variability of Blood Pressure and Coronary Heart Disease, Stroke, Heart Failure, and Mortality: A Cohort Study ONLINE FIRST
Paul Muntner, PhD; Jeff Whittle, MD; Amy I. Lynch, PhD; Lisandro D. Colantonio, MD; Lara M. Simpson, PhD; Paula T. Einhorn, MD; Emily B. Levitan, PhD; Paul K. Whelton, MD; William C. Cushman, MD; Gail T. Louis, RN; Barry R. Davis, MD; and Suzanne Oparil, MD
[+] Article, Author, and Disclosure Information
From University of Alabama at Birmingham, Birmingham, Alabama; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin; University of Texas School of Public Health, Houston, Texas; National Heart, Lung, and Blood Institute, Bethesda, Maryland; Tulane University, New Orleans, Louisiana; and University of Tennessee Health Science Center, Memphis, Tennessee.
Ann Intern Med. Published online 28 July 2015 doi:10.7326/M14-2803
Background: Variability of blood pressure (BP) across outpatient visits is frequently dismissed as random fluctuation around a patient's underlying BP.
Objective: To examine the association of visit-to-visit variability (VVV) of systolic BP (SBP) and diastolic BP with cardiovascular disease (CVD) and mortality outcomes.
Design: Prospective cohort study.
Setting: Post hoc analysis of ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).
Participants: 25 814 ALLHAT participants.
Measurements: The VVV of SBP was defined as the SD across SBP measurements obtained at 7 visits conducted from 6 to 28 months after ALLHAT enrollment. Participants without CVD events during the first 28 months of follow-up were followed from the 28-month visit through the end of active ALLHAT follow-up. Outcomes included fatal coronary heart disease (CHD) or nonfatal myocardial infarction (MI), all-cause mortality, stroke, and heart failure.
Results: During follow-up, 1194 fatal CHD or nonfatal MI events, 1948 deaths, 606 strokes, and 921 heart failure events occurred. After multivariable adjustment, including for mean SBP, the hazard ratio comparing participants in the highest versus lowest quintile of SD of SBP (≥14.4 mm Hg vs. <6.5 mm Hg) was 1.30 (95% CI, 1.06 to 1.59) for fatal CHD or nonfatal MI, 1.58 (CI, 1.32 to 1.90) for all-cause mortality, 1.46 (CI, 1.06 to 2.01) for stroke, and 1.25 (CI, 0.97 to 1.61) for heart failure. Higher VVV of diastolic BP was also associated with CVD events and mortality.
Limitation: Long-term outcomes were not available.
Conclusion: Higher VVV of SBP is associated with an increased risk for CVD and mortality. Future studies should examine whether reducing VVV of BP lowers this risk.
Primary Funding Source: National Institutes of Health.
