Blood pressure control measures and cardiovascular outcomes: a prospective hypertensive cohort

We investigated whether blood pressure (BP) control measures, visit-to-visit BP variability, and time in therapeutic range (TTR) are associated with future cardiovascular outcomes in hypertensive patients. Among 1,408 hypertensive patients without cardiovascular disease, we prospectively evaluated the incident major cardiovascular events over 6 years. In newly diagnosed patients, antihypertensive drug treatment was initiated. We estimated two markers of on-treatment BP control, (1) visit-to-visit BPV as the coefficient of variation of office systolic BP (BP-CV), and (2) TTR calculated as the percentage of office systolic BP measurements within 120–140mmHg across visits. The hypertensive cohort (672 males, mean age 60 years, 31% newly diagnosed) had a mean systolic/diastolic BP of 142/87 mmHg. The mean number of visits was 4.9 ± 2.6, while the mean attained systolic/diastolic BP during follow-up was 137/79 mmHg using 2.7 ± 1.1 antihypertensive drugs. The BP-CV and TTR were 9.1 ± 4.1% and 45 ± 29%, respectively, and the incidence of the composite outcome was 8.3% (<i>n</i> = 117). After adjustment for relevant confounders and standardization to z-scores, BP-CV and TTR were associated with a 43% (95% CI, 27–62%) increase and a 33% (95% CI, 15–47%) reduction in the outcome. However, the joint evaluation of TTR and BP-CV in a common multivariable model indicated that a standardized change of TTR was associated with the outcome to a greater extent than BP-CV (mean hazard ratios of 30% vs. 24%, respectively). When combined with the higher BP standardized-CV quartile, the lower TTR quartile predicted the outcome by 2.3 times (95% CI, 1.1–5.4) compared to the inverse TTR and BP-CV quartile pattern. High BP-CV or low TTR was associated with future cardiovascular events in a cohort of treated hypertensive patients. As a determinant, the extent of TTR value appears greater than BP-CV when these measures are considered in the same multivariable model.

本研究旨在探讨高血压患者的血压（BP）控制措施、诊间血压变异性以及治疗达标时间占比（TTR）是否与未来心血管结局相关。我们纳入1408例无心血管疾病的高血压患者，对其6年随访期间的新发主要心血管事件进行前瞻性评估。对于新诊断的高血压患者，我们启动了降压药物治疗。我们评估了两项治疗中血压控制指标：（1）诊间血压变异性以诊室收缩压变异系数（BP-CV）表示；（2）TTR，即各随访诊室收缩压处于120~140毫米汞柱范围内的测量值占比。本研究的高血压队列共纳入672例男性，平均年龄60岁，其中31%为新诊断患者，基线平均收缩压/舒张压为142/87毫米汞柱。患者平均随访次数为4.9±2.6次，随访期间平均达到的收缩压/舒张压为137/79毫米汞柱，患者平均使用2.7±1.1种降压药物。该队列的BP-CV及TTR分别为9.1±4.1%与45±29%，复合终点事件发生率为8.3%（n=117）。在对相关混杂因素进行校正并转换为Z分数标准化后，BP-CV升高与结局事件风险增加43%相关（95%置信区间：27%~62%），而TTR升高则与结局事件风险降低33%相关（95%置信区间：15%~47%）。然而，在同一多变量模型中联合评估TTR与BP-CV时发现，TTR的标准化变化对结局的影响程度大于BP-CV（平均风险比分别为30%与24%）。当与较高的BP标准化变异系数四分位组相结合时，较低的TTR四分位组预测结局事件的风险是TTR与BP-CV四分位组呈反向分布者的2.3倍（95%置信区间：1.1~5.4）。在接受治疗的高血压患者队列中，高BP-CV或低TTR均与未来心血管事件相关。当在同一多变量模型中同时考量这两项指标时，TTR对结局的影响程度似乎大于BP-CV。