门诊患者的血压变异性常被忽略。近期，美国学者对血压变异性与冠心病(CVD)和死亡的关系进行了一项前瞻性队列研究。结果表明，较高的收缩压变异性与CVD和死亡风险增加有关，未来应针对减少血压变异性是否可以降低这种风险进行进一步的评估。相关论文7月29日在线发表于《内科学文献》(Ann Intern Med)。

        该研究为ALLHAT研究的事后分析，共纳入25814例受试者。以入组后6个月至28个月期间7次随访获得的收缩压标准差(SD)定义为收缩压变异性。对首个28个月随访期间无CVD事件的受试者进行持续的随访，直至ALLHAT研究结束。转归包括致死性冠心病(CHD)或非致死性心肌梗死(MI)、全因死亡、卒中和心力衰竭。

        结果显示，在随访期间，发生CHD或非致死性MI事件、死亡、卒中和心力衰竭数分别为1194例、1948例、606例和921例。经过多变量校正后(包括平均收缩压)，收缩压最高五分位数和最低五分位数患者相比，CHD或非致死性MI、全因死亡、卒中和心力衰竭的危险比分别为1.30、1.58、1.46和1.25。舒张压变异性较高也与CVD事件和死亡有关。

        参考文献：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.