Patient-specific multifactorial mortality risk assessment using classification and regression tree analysis in the context of ambulatory blood pressure monitoring.

IF 2.7 4区 医学 Q2 UROLOGY & NEPHROLOGY Journal of Nephrology Pub Date : 2024-11-06 DOI:10.1007/s40620-024-02128-x
Bahar Tekin Çetin, Nuri Baris Hasbal, Enes Cevik, Ozgun Ekin Sahin, Merve Akyol, Zeynepgul Kalay, Duygu Ucku, Cem Tanriover, Mustafa Güldan, Lasin Özbek, Onur Memetoglu, Mert Emre Erden, Sidar Copur, Ianis Siriopol, Dimitrie Siriopol, Paola Ciceri, Mario Cozzolino, Mehmet Kanbay
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Abstract

Background: Ambulatory blood pressure monitoring is essential for understanding blood pressure patterns beyond clinical visits, aiding in risk assessment, treatment evaluation, and managing hypertension. This retrospective cohort study aimed to identify risk factors for all-cause mortality and major cardiovascular events in patients who underwent ambulatory blood pressure monitoring.

Methodology: Eligible participants aged 18 or older, with an estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73 m2, who underwent ambulatory blood pressure monitoring for various reasons, were included in the study. Data were gathered through telephone interviews, electronic health records, and the national health record system. Descriptive analysis and classification and regression tree modeling were used to uncover significant risk factors related to all-cause mortality and cardiovascular events, and to assess the model's performance compared to traditional Cox survival analysis.

Results: The study included 1291 patients, primarily male (51.8%) with a mean age of 61.1 ± 15.2 years. During a mean follow-up of 46.9 months, 76 (5.9%) patients died of any cause, and 195 (15.1%) had a cardiovascular event. The highest survival rates were observed in patients with a diastolic blood pressure (BP) dipping percentage between - 2% and 29%, nighttime systolic BP variability below 32 mmHg, and age below 72. Conversely, smokers with a diastolic BP dipping percentage below - 10% showed the lowest survival rates. The best cardiovascular outcomes were observed in patients with diastolic BP dipping above - 11%, nighttime mean systolic BP < 144 mmHg, no statin use, normotensive status, and daytime mean heart rate ≥ 60 bpm. Conversely, the worst outcomes were seen in patients with diastolic BP dipping below - 11% and a morning surge ≥ 14 mmHg. In all-cause mortality and cardiovascular event analysis, the combined model demonstrated excellent calibration and predictive power, like the classification and regression tree model and traditional analysis.

Conclusion: These findings highlight the potential of a combined model for assessing mortality and cardiovascular event risk in patients who have undergone ambulatory blood pressure monitoring.

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在非卧床血压监测中使用分类和回归树分析法进行患者特异性多因素死亡风险评估。
背景:非卧床血压监测对于了解临床就诊以外的血压模式、帮助风险评估、治疗评估和管理高血压至关重要。这项回顾性队列研究旨在确定接受非卧床血压监测的患者全因死亡率和主要心血管事件的风险因素:研究对象包括年龄在 18 岁或以上、估计肾小球滤过率(eGFR)大于 60 ml/min/1.73 m2 且因各种原因接受非卧床血压监测的合格参与者。数据通过电话访谈、电子健康记录和国民健康记录系统收集。研究采用描述性分析、分类和回归树模型来揭示与全因死亡率和心血管事件相关的重要风险因素,并评估该模型与传统 Cox 生存分析相比的性能:该研究共纳入了 1291 名患者,主要为男性(51.8%),平均年龄为 61.1 ± 15.2 岁。在平均 46.9 个月的随访期间,76 名患者(5.9%)因各种原因死亡,195 名患者(15.1%)发生了心血管事件。舒张压(BP)下降百分比在-2%至29%之间、夜间收缩压变化低于32毫米汞柱、年龄低于72岁的患者存活率最高。相反,舒张压下降率低于-10%的吸烟者存活率最低。舒张压下降率高于-11%、夜间平均收缩压为-11%的患者心血管预后最好:这些研究结果凸显了采用综合模型评估接受动态血压监测患者的死亡率和心血管事件风险的潜力。
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来源期刊
Journal of Nephrology
Journal of Nephrology 医学-泌尿学与肾脏学
CiteScore
5.60
自引率
5.90%
发文量
289
审稿时长
3-8 weeks
期刊介绍: Journal of Nephrology is a bimonthly journal that considers publication of peer reviewed original manuscripts dealing with both clinical and laboratory investigations of relevance to the broad fields of Nephrology, Dialysis and Transplantation. It is the Official Journal of the Italian Society of Nephrology (SIN).
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