Abstract：
BACKGROUND: The predictive role of blood pressure variability for all-cause mortality and fatal and nonfatal cardiovascular events has been described in the general population and in patients with diabetes, independently of mean BP. Although systolic blood pressure variability has been proposed as an informative measure for predicting clinical outcomes in patients with chronic kidney disease, its role in kidney transplant recipients is still debatable.
RESULTS: We performed a retrospective, observational, monocentric analysis of all kidney transplant recipients in follow-up at the outpatient Nephrology Clinic of San Martino Hospital from January 1, 2016 to December 31, 2016, who underwent kidney transplantation >12 months. The primary outcome was a fatal or nonfatal cardiovascular event (myocardial infarction, unstable angina, stroke, and hospitalization for heart failure). Visit-to-visit systolic blood pressure variability was expressed as the SD of systolic blood pressure values recorded at baseline and 3 months up to 18 months. Among the 272 patients (mean age, 64±13; 63% men) included in the present analyses, for each increase of 2.7 mm Hg in systolic blood pressure SD, the risk for events increased 3-fold (hazard ratio [HR], 3.1 [95% CI, 1.19-7.88]; P=0.02), and patients in the highest tertile of systolic blood pressure SD showed a 4-fold increased risk (HR, 4.1 [95% CI, 1.34-12.43]; P=0.01). This relationship was maintained even after incremental adjustment for time-averaged pulse pressure, age, diabetes, and prior cardiovascular event (HR, 3.2 [95% CI, 1.1-10.0]; P=0.04).
CONCLUSIONS: Long-term blood pressure variability represents a risk factor for cardiovascular events in kidney transplant recipients, even independently by several confounding factors including blood pressure load.
RESULTS: We performed a retrospective, observational, monocentric analysis of all kidney transplant recipients in follow-up at the outpatient Nephrology Clinic of San Martino Hospital from January 1, 2016 to December 31, 2016, who underwent kidney transplantation >12 months. The primary outcome was a fatal or nonfatal cardiovascular event (myocardial infarction, unstable angina, stroke, and hospitalization for heart failure). Visit-to-visit systolic blood pressure variability was expressed as the SD of systolic blood pressure values recorded at baseline and 3 months up to 18 months. Among the 272 patients (mean age, 64±13; 63% men) included in the present analyses, for each increase of 2.7 mm Hg in systolic blood pressure SD, the risk for events increased 3-fold (hazard ratio [HR], 3.1 [95% CI, 1.19-7.88]; P=0.02), and patients in the highest tertile of systolic blood pressure SD showed a 4-fold increased risk (HR, 4.1 [95% CI, 1.34-12.43]; P=0.01). This relationship was maintained even after incremental adjustment for time-averaged pulse pressure, age, diabetes, and prior cardiovascular event (HR, 3.2 [95% CI, 1.1-10.0]; P=0.04).
CONCLUSIONS: Long-term blood pressure variability represents a risk factor for cardiovascular events in kidney transplant recipients, even independently by several confounding factors including blood pressure load.
摘要：
背景：已经在普通人群和糖尿病患者中描述了血压变异性对全因死亡率和致命和非致命心血管事件的预测作用，独立于平均BP。尽管收缩压变异性已被提出作为预测慢性肾脏病患者临床结局的信息性指标，它在肾移植受者中的作用仍有争议。
结果：我们进行了回顾性研究，观察,对2016年1月1日至2016年12月31日在圣马蒂诺医院门诊肾内科随访的所有肾移植受者进行单中心分析，这些受者接受肾移植>12个月。主要结局是致命或非致命的心血管事件（心肌梗死，不稳定型心绞痛,中风,和因心力衰竭住院)。访视收缩压变异性表示为在基线和3个月至18个月记录的收缩压值的SD。在272名患者中(平均年龄，64±13；63%的男性)包括在本分析中，收缩压SD每增加2.7mmHg，事件的风险增加了3倍(风险比[HR]，3.1[95%CI，1.19-7.88]；P=0.02)，收缩压最高的患者SD显示出4倍的风险增加（HR，4.1[95%CI，1.34-12.43]；P=0.01）。即使在对时间平均脉压进行增量调整后，这种关系仍得以维持。年龄,糖尿病,和先前的心血管事件(HR，3.2[95%CI，1.1-10.0]；P=0.04）。
结论：长期血压变异性是肾移植受者心血管事件的危险因素，甚至独立地受到几个混杂因素的影响，包括血压负荷。
结果：我们进行了回顾性研究，观察,对2016年1月1日至2016年12月31日在圣马蒂诺医院门诊肾内科随访的所有肾移植受者进行单中心分析，这些受者接受肾移植>12个月。主要结局是致命或非致命的心血管事件（心肌梗死，不稳定型心绞痛,中风,和因心力衰竭住院)。访视收缩压变异性表示为在基线和3个月至18个月记录的收缩压值的SD。在272名患者中(平均年龄，64±13；63%的男性)包括在本分析中，收缩压SD每增加2.7mmHg，事件的风险增加了3倍(风险比[HR]，3.1[95%CI，1.19-7.88]；P=0.02)，收缩压最高的患者SD显示出4倍的风险增加（HR，4.1[95%CI，1.34-12.43]；P=0.01）。即使在对时间平均脉压进行增量调整后，这种关系仍得以维持。年龄,糖尿病,和先前的心血管事件(HR，3.2[95%CI，1.1-10.0]；P=0.04）。
结论：长期血压变异性是肾移植受者心血管事件的危险因素，甚至独立地受到几个混杂因素的影响，包括血压负荷。
