比利时鲁汶大学等机构的研究人员近日取得一项新成果。他们统计了动态血压（BP）与死亡率和心血管结局的关系。这一研究成果于2019年8月6日发表在国际顶尖学术期刊《美国医学会杂志》上。

目前还不确定哪个BP指数与这些结果最密切相关。 在一项人群队列研究中，共有11135名来自欧洲、亚洲和南美的成年人参与。结果发现较高的24小时血压和夜间血压与死亡风险和心血管事件显著相关，包括心血管死亡与非致命性冠状动脉事件、心力衰竭或中风。该相关性在消除了办公机器或门诊血压测量值的误差后仍然如此。因此，24小时血压和夜间血压可被认为是估计心血管风险的最佳测量指标，尽管从统计上看，与其他血压指标相比，该模型的改善幅度很小。

研究人员表示，血压是已知的总体死亡率和致命性-非致命性心血管（CV）事件的危险因素。

附：英文原文

Title: Association of Office and Ambulatory Blood Pressure With Mortality and Cardiovascular Outcomes

Author: Wen-Yi Yang, Jesus D. Melgarejo, Lutgarde Thijs

Issue&Volume: Vol 322, No.5

Abstract:

Importance  Blood pressure (BP) is a known risk factor for overall mortality and cardiovascular (CV)-specific fatal and nonfatal outcomes. It is uncertain which BP index is most strongly associated with these outcomes.

Objective  To evaluate the association of BP indexes with death and a composite CV event.

Design, Setting, and Participants  Longitudinal population-based cohort study of 11?135 adults from Europe, Asia, and South America with baseline observations collected from May 1988 to May 2010 (last follow-ups, August 2006-October 2016).

Exposures  Blood pressure measured by an observer or an automated office machine; measured for 24 hours, during the day or the night; and the dipping ratio (nighttime divided by daytime readings).

Main Outcomes and Measures  Multivariable-adjusted hazard ratios (HRs) expressed the risk of death or a CV event associated with BP increments of 20/10 mm Hg. Cardiovascular events included CV mortality combined with nonfatal coronary events, heart failure, and stroke. Improvement in model performance was assessed by the change in the area under the curve (AUC).

Results  Among 11?135 participants (median age, 54.7 years, 49.3% women), 2836 participants died (18.5 per 1000 person-years) and 2049 (13.4 per 1000 person-years) experienced a CV event over a median of 13.8 years of follow-up. Both end points were significantly associated with all single systolic BP indexes (P < .001). For nighttime systolic BP level, the HR for total mortality was 1.23 (95% CI, 1.17-1.28) and for CV events, 1.36 (95% CI, 1.30-1.43). For the 24-hour systolic BP level, the HR for total mortality was 1.22 (95% CI, 1.16-1.28) and for CV events, 1.45 (95% CI, 1.37-1.54). With adjustment for any of the other systolic BP indexes, the associations of nighttime and 24-hour systolic BP with the primary outcomes remained statistically significant (HRs ranging from 1.17 [95% CI, 1.10-1.25] to 1.87 [95% CI, 1.62-2.16]). Base models that included single systolic BP indexes yielded an AUC of 0.83 for mortality and 0.84 for the CV outcomes. Adding 24-hour or nighttime systolic BP to base models that included other BP indexes resulted in incremental improvements in the AUC of 0.0013 to 0.0027 for mortality and 0.0031 to 0.0075 for the composite CV outcome. Adding any systolic BP index to models already including nighttime or 24-hour systolic BP did not significantly improve model performance. These findings were consistent for diastolic BP.

Conclusions and Relevance  In this population-based cohort study, higher 24-hour and nighttime blood pressure measurements were significantly associated with greater risks of death and a composite CV outcome, even after adjusting for other office-based or ambulatory blood pressure measurements. Thus, 24-hour and nighttime blood pressure may be considered optimal measurements for estimating CV risk, although statistically, model improvement compared with other blood pressure indexes was small.

DOI: 10.1001/jama.2019.9811

Source: https://jamanetwork.com/journals/jama/article-abstract/2740719