Hoshide Yoko, Kario Kazuomi, Schwartz Joseph E, Hoshide Satoshi, Pickering Thomas G, Shimada Kazuyuki
Department of Cardiology, Jichi Medical School, Tochigi, Japan.
Am J Hypertens. 2002 Oct;15(10 Pt 1):844-50. doi: 10.1016/s0895-7061(02)03020-0.
To determine whether the benefits of antihypertensive treatment vary according to dipper status, 811 asymptomatic elderly Japanese hypertensives underwent 24-h ambulatory blood pressure monitoring. During a mean follow-up period of 41 months, 32 stroke events were observed in patients who remained nonmedicated (n = 385), and in 27 patients in the medicated group (n = 426), indicating a 24% lower rate of stroke as a result of antihypertensive therapy. Patients were divided into a white-coat hypertensive (WCHT) group (ambulatory blood pressure <130/80 mm Hg; n = 236) and a sustained hypertensive (SHT) group (n = 575). Sixty-one percent of SHT and 32% of WCHT patients were being medicated. In the SHT group, the stroke rates were 12.4% in nonmedicated and 7.4% in medicated group (P =.04), whereas in the WCHT group the stroke rates were 2.5% in nonmedicated and 1.3% in medicated group (P = not significant). The SHT were further classified according to their nocturnal systolic blood pressure (BP) decrease, as follows: 97 extreme-dippers with >20% nocturnal systolic BP decrease; 230 dippers with >10% but <20% decrease; 185 nondippers with >0% but <10% decrease; 63 reverse-dippers with <0% decrease. In the dipping groups of SHT, the stroke rates were similar according to medication versus no-medication in extreme-dippers (12% v 13%), and reverse-dippers (23% v 22%), but in nondippers there was a significantly lower rate (by 65%, P =.038) in the medicated (4.4%) than the nonmedicated (13%) groups. In dippers, the stroke rate was also lower in the medicated than the nonmedicated patients (4.7% v 8.8%), a decrease of 47% (P =.217), although the difference was not significant. In conclusion, in older SHT subjects, antihypertensive therapy using clinic BP may be less effective for the groups with extremely abnormal diurnal BP patterns (extreme-dippers and reverse-dippers) than those with relatively normal patterns (dippers and nondippers). Patients with WCHT also showed no benefit.
为了确定降压治疗的益处是否因血压勺型状态而异，811名无症状的日本老年高血压患者接受了24小时动态血压监测。在平均41个月的随访期内，未接受药物治疗的患者（n = 385）中有32例发生中风事件，接受药物治疗的患者（n = 426）中有27例发生中风事件，这表明降压治疗使中风发生率降低了24%。患者被分为白大衣高血压（WCHT）组（动态血压<130/80 mmHg；n = 236）和持续性高血压（SHT）组（n = 575）。61%的SHT患者和32%的WCHT患者正在接受药物治疗。在SHT组中，未接受药物治疗的患者中风发生率为12.4%，接受药物治疗的患者中风发生率为7.4%（P = 0.04），而在WCHT组中，未接受药物治疗的患者中风发生率为2.5%，接受药物治疗的患者中风发生率为1.3%（P = 无统计学意义）。SHT患者根据夜间收缩压（BP）下降情况进一步分类如下：97例极端勺型患者夜间收缩压下降>20%；230例勺型患者下降>10%但<20%；185例非勺型患者下降>0%但<10%；63例反勺型患者下降<0%。在SHT的勺型组中，极端勺型患者（12%对13%）和反勺型患者（23%对22%）接受药物治疗与未接受药物治疗的中风发生率相似，但在非勺型患者中，接受药物治疗的患者（中风发生率4.4%）比未接受药物治疗的患者（中风发生率13%）显著降低（降低65%，P = 0.038）。在勺型患者中，接受药物治疗的患者中风发生率也低于未接受药物治疗的患者（4.7%对8.8%），降低了47%（P = 0.217），尽管差异无统计学意义。总之，在老年SHT患者中，使用诊室血压进行降压治疗对昼夜血压模式异常极端的组（极端勺型和反勺型）可能不如对模式相对正常的组（勺型和非勺型）有效。WCHT患者也未显示出益处。
