中国全科医学2026，Vol.29Issue(15)：1998-2005,2013,9.DOI:10.12114/j.issn.1007-9572.2025.0236
亚临床高风险人群夜间高血压筛查模型的构建与验证:一项单中心队列研究
Development and Validation of a Nighttime Hypertension Screening Model for Subclinical High-risk Populations:a Single-center Cohort Study
摘要
Abstract
Background Nocturnal hypertension(NH)is a significant contributor to multi-organ damage(cardiovascular,cerebral,and renal)and serves as a predictor of all-cause mortality.Its predictive value surpasses that of daytime blood pressure and office blood pressure.Classified as a form of masked hypertension due to its occult nature during nocturnal sleep,early screening and individualized treatment can mitigate the risk of cardiovascular,cerebral,and renal diseases.Objective To investigate risk factors associated with NH by leveraging routine health checkup parameters and personal health data,and to develop a clinical predictive nomogram model for NH.Methods A total of 406 patients who underwent 24-hour ambulatory blood pressure monitoring(ABPM)at the Affiliated Hospital of Inner Mongolia Medical University between January 1,2021,and June 30,2024,were included.Baseline clinical data,laboratory test results,and echocardiographic findings were collected.Patients were randomly divided into a training set(n=284)and a validation set(n=122)in a 7∶3 ratio.A risk prediction model for NH was constructed using LASSO regression analysis and multivariate Logistic regression analysis,followed by Nomogram development.The ROC curve was plotted,and the area under the ROC curve(AUC)was calculated to validate the model's accuracy.Calibration curves were generated to assess the model's predictive capability and consistency between predicted and observed risks.Results Based on 24-hour ABPM results,patients were categorized into an NH group(n=254)and a non-NH group(n=152).Four predictors identified via LASSO regression"body weight,total cholesterol(TC),hypertension,and stroke"were used as independent variables in multivariate Logistic regression analysis.The results indicated that increased body weight(OR=1.029,95%CI=1.006-1.053),elevated TC(OR=1.496,95%CI=1.136-1.972),hypertension(OR=2.372,95%CI=1.214-4.632),and stroke(OR=7.850,95%CI=4.157-14.824)were all risk factors for NH(P<0.05).The Nomogram revealed that stroke history(score:0 or 62)and hypertension(score:0 or 26)had a more pronounced impact on diagnostic rates compared to body weight and TC(scores varied linearly with variable values).The total model score was 240,with a 95%risk of NH when the score exceeded 176.ROC curve analysis demonstrated an AUC of 0.791(95%CI=0.739-0.843)in the training set,with a sensitivity of 0.698 and specificity of 0.786.In the validation set,the AUC was 0.820(95%CI=0.742-0.899),with a sensitivity of 0.817 and specificity of 0.725.The Hosmer-Lemeshow calibration curve indicated good model fit,and decision curve analysis showed that the validation set achieved high net benefit within a threshold probability range of 0.2-0.6,confirming optimal clinical utility.Conclusion This study established an NH risk prediction model incorporating four clinical indicators:body weight,TC,hypertension history,and stroke history.The model demonstrates robust calibration,discrimination,and clinical applicability for screening NH risk in suspected patients.关键词
高血压/夜间高血压/风险预测模型/列线图Key words
Hypertension/Nocturnal hypertension/Risk prediction model/Nomogram分类
医药卫生引用本文复制引用
刘帆,陈秋雨,李婧..亚临床高风险人群夜间高血压筛查模型的构建与验证:一项单中心队列研究[J].中国全科医学,2026,29(15):1998-2005,2013,9.基金项目
国家自然科学基金资助项目(82260075) （82260075）
内蒙古医科大学附属医院高层次人才培养项目"航行系列"(QH202402) （QH202402）
内蒙古医科大学创客培育项目(101322024101) （101322024101）
