隐蔽性高血压清晨血压波动与心脑血管事件的关系
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摘要
目的探讨隐蔽性高血压(MH)与清晨血压波动及心脑血管事件的关系。方法入选2016年2月至2017年7月烟台市莱阳中心医院心内科住院及门诊诊室血压<140/90 mm Hg的非高血压受试者320例,年龄40～79岁,由同一研究小组完成24 h动态血压监测,根据24 h平均收缩压≥130和(或)24 h平均舒张压≥80 mm Hg与否分为正常血压组(n=194)和MH组(n=126),分析两组动态血压参数的差异,随访并比较两组患者主要心脑血管事件(MACCE)的发生情况,随访终止时间为2018年6月,随访终点事件为新发心肌梗死、脑卒中或心源性死亡。结果 MH组体质量指数、吸烟及糖尿病比例、空腹血糖及糖化血红蛋白(HbA1c)水平高于正常血压组(均P<0.05)。MH组24 h平均收缩压(24hSBP)、白天平均收缩压(dSBP)、夜间平均收缩压(nSBP)、白天收缩压平台、夜间收缩压平台、清晨收缩压上升速度[(14.9±9.3)比(11.2±9.2) mm Hg/h]高于正常血压组(均P<0.01),MH组平均动脉压(MAP)、舒张压各参数水平也高于正常血压组(均P<0.05)。MH组MACCE发生率高于正常血压组(7.14%比2.06%,P<0.05)。Kaplan-Meier生存分析显示:MH患者发生MACCE风险明显增加(P=0.009),糖尿病患者MACCE发生风险高于非糖尿病患者(P=0.025)。多变量Cox回归分析显示:MH组清晨收缩压上升速度(HR=1.589,95%CI 1.161～2.175,P=0.004)、白天收缩压平台水平(HR=1.155,95%CI 1.005～1.327,P=0.042)是MACCE发生的危险因素。结论 MH患者白天收缩压平台水平升高和清晨收缩压上升速度加快可能是MACCE的危险因素。
Objective To evaluate the relationship between the morning blood pressure surge and cardio-cerebral vascular events in masked hypertension(MH) patients. Methods A total of 320 subjects aged 40-79 years old hospitalized in Cardiology Department of Laiyang Central Hospital of Yantai city from February 2016 to July 2017 were included and divided into two groups: normotension group(n=194; clinic blood pressure<140/90 mm Hg; 24-hour blood pressure<130/80 mm Hg) and MH group(n=126; clinic blood pressure<140/90 mm Hg; 24-hour blood pressure≥130/80 mm Hg). The difference of 24 h ambulatory blood pressure value between two groups and its association with major adverse cardio-cerebral vascular events(MACCE) during follow up were analyzed. Results Body mass index(BMI), smoking status, diabetes status, fasting plasma glucose and hemoglobin A1 c(HbA1 c) were higher in MH group than those in normotension group(all P<0.05). Levels of 24 h mean systolic blood pressure(24 hSBP), daytime mean systolic blood pressure(dSBP), nighttime mean systolic blood pressure(nSBP), daytime systolic blood pressure(SBP) plateau and increasing rate of morning SBP [(14.9±9.3) vs(11.2±9.2) mm Hg/h] in MH group were significantly higher than that in normotension group(all P<0.01). The incidence of MACCE in MH group was higher than that in normotension group(7.14% vs 2.06%, P<0.05). Kaplan-Meier survival curves showed that MACCE was significantly higher in MH group(P=0.009) and patients with diabetes(P=0.025). Multivariable Cox regression analysis showed that the increasing rate of morning SBP(HR=1.589, 95% CI 1.161-2.175, P=0.004) and daytime SBP plateau(HR=1.155, 95% CI 1.005-1.327, P=0.042) were risk factors for MACCE in MH group. Conclusion The acceleration of daytime SBP plateau and increasing rate of morning SBP may be the risk factors for MACCE in MH patients.
Objective To evaluate the relationship between the morning blood pressure surge and cardio-cerebral vascular events in masked hypertension(MH) patients. Methods A total of 320 subjects aged 40-79 years old hospitalized in Cardiology Department of Laiyang Central Hospital of Yantai city from February 2016 to July 2017 were included and divided into two groups: normotension group(n=194; clinic blood pressure<140/90 mm Hg; 24-hour blood pressure<130/80 mm Hg) and MH group(n=126; clinic blood pressure<140/90 mm Hg; 24-hour blood pressure≥130/80 mm Hg). The difference of 24 h ambulatory blood pressure value between two groups and its association with major adverse cardio-cerebral vascular events(MACCE) during follow up were analyzed. Results Body mass index(BMI), smoking status, diabetes status, fasting plasma glucose and hemoglobin A1 c(HbA1 c) were higher in MH group than those in normotension group(all P<0.05). Levels of 24 h mean systolic blood pressure(24 hSBP), daytime mean systolic blood pressure(dSBP), nighttime mean systolic blood pressure(nSBP), daytime systolic blood pressure(SBP) plateau and increasing rate of morning SBP [(14.9±9.3) vs(11.2±9.2) mm Hg/h] in MH group were significantly higher than that in normotension group(all P<0.01). The incidence of MACCE in MH group was higher than that in normotension group(7.14% vs 2.06%, P<0.05). Kaplan-Meier survival curves showed that MACCE was significantly higher in MH group(P=0.009) and patients with diabetes(P=0.025). Multivariable Cox regression analysis showed that the increasing rate of morning SBP(HR=1.589, 95% CI 1.161-2.175, P=0.004) and daytime SBP plateau(HR=1.155, 95% CI 1.005-1.327, P=0.042) were risk factors for MACCE in MH group. Conclusion The acceleration of daytime SBP plateau and increasing rate of morning SBP may be the risk factors for MACCE in MH patients.
引文
[1] Eguchi K, Pickering TG, Hoshide S, et al. Ambulatory blood pressure is a better marker than clinic blood pressure in predicting cardiovascular events in patients with/without type 2 diabetes[J].Am J Hypertens,2008,21(4):443-450.
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[3] 许耀,郝云霞,崔爱东,等. 吸烟对男性高血压患者清晨血压上升速度的影响[J].中华高血压杂志,2012,20(2):141-145.
[4] Cuspidi C, Sala C, Tadic M, et al. Untreated masked hypertension and subclinical cardiac damage: a systematic review and meta-analysis[J].Am J Hypertens,2015,28(6):806-813.
[5] Tientcheu D, Ayers C, Das SR, et al. Target organ complications and cardiovascular events associated with masked hypertension and white-coat hypertension: analysis from the Dallas heart study[J].J Am Coll Cardiol,2015,66(20):2159-2169.
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[7] Head GA, Lukoshkova EV, Reid CM. Nonsymmetrical double Logistic analysis of ambulatory blood pressure recordings[J].J Appl Physiol,2005,98(4):1511-1518.
[8] Luo Y, Wang YL, Wu YB, et al. Association between the rate of the morning surge in blood pressure and cardiovascular events and stroke[J].Chin Med J,2013,126 (3) :510-514.
[9] Omboni S, Aristizabal D, De La Sierra A, et al. Hypertension types defined by clinic and ambulatory blood pressure in 14 143 patients referred to hypertension clinics world-wide. Data from the ARTEMIS study[J].J Hypertens,2016,34(11):2187-2198.
[10] Booth JN, 3rd, Diaz KM, Seals SR, et al. Masked hypertension and cardiovascular disease events in a prospective cohort of blacks: the Jackson heart study[J].Hypertension,2016,68(2):501-510.
[11] Franklin SS, Thijs L, Li Y, et al. Masked hypertension in diabetes mellitus: treatment implications for clinical practice[J].Hypertension,2013,61(5):964-971.
[12] Leitao CB, Canani LH, Kramer CK, et al. Masked hypertension, urinary albumin excretion rate, and echocardiographic parameters in putatively normotensive type 2 diabetic patients[J].Diabetes Care,2007,30(5):1255-1260.
[13] Yuan M, Chen W, Teng B, et al. Occupational disparities in the association between self-reported salt-eating habit and hypertension in older adults in Xiamen, China[J].Int J Environ Res Public Health,2016,13(1):148.
[14] Oh SW, Han KH, Han SY, et al. Association of sodium excretion with metabolic syndrome, insulin resistance, and body fat[J].Medicine (Baltimore),2015,94(39):e1650.
[15] Satoh M, Asayama K, Kikuya M, et al. Long-term stroke risk due to partial white-coat or masked hypertension based on home and ambulatory blood pressure measurements: the Ohasama study[J].Hypertension,2016,67(1):48-55.
[16] Conen D, Aeschbacher S, Thijs L, et al. Age-specific differences between conventional and ambulatory daytime blood pressure values[J].Hypertension,2014,64(5):1073-1079.
[17] Kushiro T, Kario K, Saito I, et al. Increased cardiovascular risk of treated white coat and masked hypertension in patients with diabetes andchronic kidney disease: the HONEST study[J].Hypertens Res,2017,40(1):87-95.
[18] Gijón-Conde T, Graciani A, López-Garcí a E, et al. Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain[J].Hypertens Res,2017,40(6):613-619.
[19] Pierdomenico SD, Cuccurullo F. Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis[J].Am J Hypertens,2011,24(1):52-58.
[20] Sheppard JP, Hodgkinson J, Riley R, et al. Prognostic significance of the morning blood pressure surge in clinical practice: a systematic review[J].Am J Hypertens,2015,28(1):30-41.
[21] 中国高血压联盟, 中国医师协会高血压专业委员会血压测量与监测工作委员会,《中华高血压杂志》编委会.动态血压监测临床应用中国专家共识[J].中华高血压杂志,2015,23(8):727-730.
[2] Yu JM, Kong QY, Schoenhagen P, et al. The prognostic value of long-term visit-to-visit blood pressure variability on stroke in real-world practice: a dynamic cohort study in a large representative sample of Chinese hypertensive population[J].Int J Cardiol,2014,177(3):995-1000.
[3] 许耀,郝云霞,崔爱东,等. 吸烟对男性高血压患者清晨血压上升速度的影响[J].中华高血压杂志,2012,20(2):141-145.
[4] Cuspidi C, Sala C, Tadic M, et al. Untreated masked hypertension and subclinical cardiac damage: a systematic review and meta-analysis[J].Am J Hypertens,2015,28(6):806-813.
[5] Tientcheu D, Ayers C, Das SR, et al. Target organ complications and cardiovascular events associated with masked hypertension and white-coat hypertension: analysis from the Dallas heart study[J].J Am Coll Cardiol,2015,66(20):2159-2169.
[6] Melgarejo JD, Maestre GE, Thijs L, et al. Prevalence, treatment, and control rates of conventional and ambulatory hypertension across 10 populations in 3 continents[J].Hypertension,2017,70(1):50-58.
[7] Head GA, Lukoshkova EV, Reid CM. Nonsymmetrical double Logistic analysis of ambulatory blood pressure recordings[J].J Appl Physiol,2005,98(4):1511-1518.
[8] Luo Y, Wang YL, Wu YB, et al. Association between the rate of the morning surge in blood pressure and cardiovascular events and stroke[J].Chin Med J,2013,126 (3) :510-514.
[9] Omboni S, Aristizabal D, De La Sierra A, et al. Hypertension types defined by clinic and ambulatory blood pressure in 14 143 patients referred to hypertension clinics world-wide. Data from the ARTEMIS study[J].J Hypertens,2016,34(11):2187-2198.
[10] Booth JN, 3rd, Diaz KM, Seals SR, et al. Masked hypertension and cardiovascular disease events in a prospective cohort of blacks: the Jackson heart study[J].Hypertension,2016,68(2):501-510.
[11] Franklin SS, Thijs L, Li Y, et al. Masked hypertension in diabetes mellitus: treatment implications for clinical practice[J].Hypertension,2013,61(5):964-971.
[12] Leitao CB, Canani LH, Kramer CK, et al. Masked hypertension, urinary albumin excretion rate, and echocardiographic parameters in putatively normotensive type 2 diabetic patients[J].Diabetes Care,2007,30(5):1255-1260.
[13] Yuan M, Chen W, Teng B, et al. Occupational disparities in the association between self-reported salt-eating habit and hypertension in older adults in Xiamen, China[J].Int J Environ Res Public Health,2016,13(1):148.
[14] Oh SW, Han KH, Han SY, et al. Association of sodium excretion with metabolic syndrome, insulin resistance, and body fat[J].Medicine (Baltimore),2015,94(39):e1650.
[15] Satoh M, Asayama K, Kikuya M, et al. Long-term stroke risk due to partial white-coat or masked hypertension based on home and ambulatory blood pressure measurements: the Ohasama study[J].Hypertension,2016,67(1):48-55.
[16] Conen D, Aeschbacher S, Thijs L, et al. Age-specific differences between conventional and ambulatory daytime blood pressure values[J].Hypertension,2014,64(5):1073-1079.
[17] Kushiro T, Kario K, Saito I, et al. Increased cardiovascular risk of treated white coat and masked hypertension in patients with diabetes andchronic kidney disease: the HONEST study[J].Hypertens Res,2017,40(1):87-95.
[18] Gijón-Conde T, Graciani A, López-Garcí a E, et al. Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain[J].Hypertens Res,2017,40(6):613-619.
[19] Pierdomenico SD, Cuccurullo F. Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis[J].Am J Hypertens,2011,24(1):52-58.
[20] Sheppard JP, Hodgkinson J, Riley R, et al. Prognostic significance of the morning blood pressure surge in clinical practice: a systematic review[J].Am J Hypertens,2015,28(1):30-41.
[21] 中国高血压联盟, 中国医师协会高血压专业委员会血压测量与监测工作委员会,《中华高血压杂志》编委会.动态血压监测临床应用中国专家共识[J].中华高血压杂志,2015,23(8):727-730.