夜间血压变异性与老年高血压病人不良心血管事件相关

doi:10.3969/j.issn.1003-9198.2025.11.016

摘要/Abstract

摘要： 目的探讨血压变异性与老年高血压病人不良心血管事件的相关性。方法选取2022年8月至2023年3月延安大学咸阳医院收治的老年高血压病人182例,随访至2024年6月1日,根据是否发生心血管事件分为不良心血管事件组和无事件组。采用无创性携带式动态血压监测仪检测血压水平,以平均实际变异(ARV)评估血压变异性,采用Point-biserial相关分析探讨血压变异性与老年高血压病人不良心血管事件的相关性,并进一步行多因素logistic回归分析筛选影响不良心血管事件发生的独立危险因素。结果截至末次随访日期,共10例失访,最终172例纳入研究,其中39例出现终点事件,为不良心血管事件组,其余133例为无事件组。2组24 h平均收缩压(24hSBP)、24 h平均舒张压(24hDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)、24 h收缩压变异性(24hSBPV)、24 h平均舒张压变异性(24hDBPV)、日间平均收缩压变异性(dSBPV)、日间平均舒张压变异性(dDBPV)、夜间平均收缩压变异性(nSBPV)、夜间平均舒张压变异性(nDBPV)比较,差异均有统计学意义(P＜0.05)。Point-biserial相关分析显示:24hSBP、dSBP、nSBP、nDBP、24hSBPV、24hDBPV、dSBPV、dDBPV、nSBPV、nDBPV与老年高血压病人不良心血管事件呈正相关(P<0.05)。多因素logistic回归分析显示:nSBP(OR=1.129, 95%CI:1.050~1.215)、nDBP(OR=1.150, 95%CI:1.021~1.294)、nSBPV(OR=1.895, 95%CI:1.327~2.706)、nDBPV(OR=4.746, 95%CI:2.232~10.090)是老年高血压病人不良心血管事件发生的独立危险因素。结论夜间血压变异性与老年高血压病人不良心血管事件相关,监测夜间血压变异性有助于预测老年高血压病人不良心血管事件的发生。

关键词: 夜间血压, 血压变异性, 高血压, 心血管事件, 相关性

Abstract: Objective To explore the correlation between blood pressure variability and adverse cardiovascular events in the elderly hypertensive patients. Methods A total of 182 elderly hypertensive patients admitted to Xianyang Hospital, Yan’an University from August 2022 to March 2023 were selected, and were followed uptill June 1, 2024, and the patients were divided into adverse cardiovascular event group and non-event group based on whether they presented with adverse cardiovascular events. Blood pressure levels were monitored using a non-invasive portable ambulatory blood pressure monitor, and blood pressure variability was assessed using the average real variation (ARV). The correlation between blood pressure variability and adverse cardiovascular events was analyzed using Point-biserial correlation analysis, and a multivariate logistic regression analysis was conducted. Results At the end of the last follow-up, a total of 10 cases were lost to follow-up, and 172 cases were finally included in the study. A total of 39 cases presented with the endpoint events and were classified as the adverse cardiovascular event group, while the other 133 cases were enrolled in the non-event group. There were significant differences in 24 h mean systolic blood pressure (24hSBP), 24 h mean diastolic blood pressure (24hDBP), night mean systolic blood pressure (nSBP), night mean diastolic blood pressure (nDBP), 24 h systolic blood pressure variability (24hSBPV), 24 h mean diastolic blood pressure variability (24hDBPV), day mean systolic blood pressure variability (dSBPV), day mean diastolic pressure variability (dDBPV), mean nocturnal systolic pressure variability (nSBPV) and mean nocturnal diastolic pressure variability (nDBPV) between the two groups(P<0.05).Point-biserial correlation analysis showed that 24hSBP, dSBP, nSBP, nDBP, 24hSBPV, 24hDBPV, dSBPV, dDBPV, nSBPV, nDBPV were positively correlated with the adverse cardiovascular events in the elderly hypertensive patients (P<0.05). Logistic regression analysis showed that nSBP (OR=1.129,95%CI: 1.050－1.215), nDBP (OR=1.150,95%CI: 1.021－1.294), nSBPV (OR=1.895,95%CI: 1.327－2.706) and nDBPV (OR=4.746,95%CI: 2.232－10.090) were independent risk factors for adverse cardiovascular events in the elderly patients with hypertension. Conclusions Nocturnal blood pressure variability is correlated with adverse cardiovascular events in the elderly hypertensive patients. Monitoring nocturnal blood pressure variability can provide a basis for predicting adverse cardiovascular events in the elderly hypertensive patients.

Key words: nocturnal blood pressure, blood pressure variability, hypertension, cardiovascular event, correlation

中图分类号:

R 544.11

杨锦, 张肖, 赵政昆. 夜间血压变异性与老年高血压病人不良心血管事件相关[J]. 实用老年医学, 2025, 39(11): 1150-1155.

YANG Jin, ZHANG Xiao, ZHAO Zhengkun. Nocturnal blood pressure variability is correlated with adverse cardiovascular events in elderly hypertensive patients[J]. Practical Geriatrics, 2025, 39(11): 1150-1155.

参考文献

[1] 赵冬. 中国成人高血压流行病学现状[J]. 中国心血管杂志, 2020, 25(6): 513-515.
[2] 孙芹, 田伟帆, 罗婷婷, 等. 2023年世界卫生组织《全球高血压报告》解读[J]. 中国胸心血管外科临床杂志, 2024,31(2): 203-208.
[3] 黎维芳. 社区老年高血压流行病学特征分析[J]. 基层医学论坛, 2022, 26(35): 95-97.
[4] ROSEI E A, CHIARINI G, RIZZONI D. How important is blood pressure variability?[J]. Eur Heart J Suppl, 2020, 22(Suppl E): E1-E6.
[5] 季帅, 贺宇, 陈立鸿, 等. 血压变异性与常见心血管危险因素的相关性分析[J]. 临床研究, 2023, 31(2): 1-4.
[6] ERANGO M A. Bayesian joint modeling of longitudinal and survival time measurement of hypertension patients[J]. Risk Manag Healthc Policy, 2020, 13: 73-81.
[7] LI M X, ZHANG D Y, TANG S T, et al. Control status of ambulatory blood pressure and its relationship with arterial stiffness in the China nationwide registry of treated hypertensive patients: the REACTION-ABP study[J]. Hypertens Res, 2023, 46(10): 2302-2311.
[8] 中国老年医学学会高血压分会, 国家老年疾病临床医学研究中心中国老年心血管病防治联盟. 中国老年高血压管理指南2019[J]. 中国心血管杂志, 2019, 24(1): 1-23.
[9] WANG C, YUAN Y, ZHENG M, et al.Association of age of onset of hypertension with cardiovascular diseases and mortality[J]. J Am Coll Cardiol,2020,75(23):2921-2930.
[10] LEE S R, PARK C S, CHOI E K, et al. Hypertension burden and the risk of new-onset atrial fibrillation: a nationwide population-based study[J]. Hypertension, 2021, 77(3): 919-928.
[11] KRRIO K.Diversity in hypertension and cardiovascular disease around the globe[J]. Curr Hypertens Rev,2021,17(1):1-2.
[12] WANG M C, LLOYD-JONES D M. Cardiovascular risk assessment in hypertensive patients[J]. Am J Hypertens, 2021, 34(6): 569-577.
[13] BOURDILLON M T, SONG R J, MUSA YOLA I, et al. Prevalence, predictors, progression, and prognosis of hypertension subtypes in the Framingham heart study[J]. J Am Heart Assoc, 2022, 11(6): e024202.
[14] KONAR S, FLOREZ-PERDOMO W, GARCIA-BALLESTAS E, et al. Blood pressure variability and prognosis in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis[J]. J Neurosurg Sci, 2023, 67(1): 10-17.
[15] NARITA K, HOSHIDE S, KARIO K. Comparison of ambulatory and home blood pressure variability for cardiovascular prognosis and biomarkers[J]. Hypertension, 2023, 80(12): 2547-2555.
[16] HOSHIDE S, MOGI M, KARIO K. How do we tackle nighttime blood pressure?[J]. Hypertens Res, 2023, 46(10): 2262-2263.
[17] CHENG Y, SHENG C S, HUANG J F, et al. Seasonality in nighttime blood pressure and its associations with target organ damage[J]. Hypertens Res, 2023, 46(6): 1433-1441.
[18] APPIAH K O, NATH M, MANNING L, et al. Increasing blood pressure variability predicts poor functional outcome following acute stroke[J]. J Stroke Cerebrovasc Dis, 2021, 30(1): 105466.
[19] HUANG J T, CHENG H M, YU W C, et al. Increased nighttime pulse pressure variability but not ambulatory blood pressure levels predicts 14-year all-cause mortality in patients on hemodialysis[J]. Hypertension, 2019, 74(3): 660-668.
[20] WANG L, XIA X, LIU X, et al. Twenty-four-hour ambulatory blood pressure variability and association with ischemic stroke subtypes in the subacute stage[J]. Front Neurol, 2023, 14: 1139816.
[21] TAKASE H, SUGIURA T, YAMASHITA S, et al. Significance of blood pressure variability in normotensive individuals as a risk factor of developing hypertension[J]. Blood Press, 2024, 33(1): 2323967.
[22] LI H L, LIN H J, MUO C H, et al. Blood pressure variability and risk of cardiovascular events and mortality in real-world clinical settings[J]. J Am Heart Assoc, 2025, 14(11): e037658.
[23] LI J, WEI Q, LI S, et al. Prognostic value of nighttime blood pressure in patients with chronic kidney disease[J]. Hypertens Res, 2025, 48(4): 1351-1362.