Bobrie Guillaume, Chatellier Gilles, Genes Nathalie, Clerson Pierre, Vaur Laurent, Vaisse Bernard, Menard Joël, Mallion Jean-Michel
Service d'Hypertension Artérielle, Hôpital Européen Georges Pompidou, Paris, France.
JAMA. 2004 Mar 17;291(11):1342-9. doi: 10.1001/jama.291.11.1342.
Blood pressure (BP) measurement in clinicians' offices with a mercury sphygmomanometer has numerous drawbacks. In contrast, the use of home BP measurement improves measurement precision and reproducibility. However, data about its prognostic value are lacking.
To assess the prognostic value of home vs office BP measurement by general practitioners in a European population of elderly patients being treated for hypertension.
DESIGN, SETTING, AND PARTICIPANTS: Office and home BP and cardiac risk factors were measured at baseline in a cohort of 4939 treated hypertensive patients (mean age, 70 [SD, 6.5] years; 48.9% men) who were recruited and followed up by their usual general practitioners without specific recommendations about their management. The cohort was then followed up for a mean of 3.2 (SD, 0.5) years. The thresholds defining uncontrolled hypertension were at least 140/90 mm Hg for office BP and 135/85 mm Hg for home BP.
The primary end point was cardiovascular mortality. Secondary end points were total mortality and the combination of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, transient ischemic attack, hospitalization for angina or heart failure, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery.
At the end of follow-up, clinical status was known for 99.9% of patients. At least 1 cardiovascular event had occurred in 324 (incidence, 22.2/1000 patient-years). For BP self-measurement at home, each 10-mm Hg increase in systolic BP increased the risk of a cardiovascular event by 17.2% (95% confidence interval [CI], 11.0%-23.8%) and each 5-mm Hg increase in diastolic BP increased that risk by 11.7% (95% CI, 5.7%-18.1%). Conversely, for the same increase in BP observed using office measurement, there was no significant increase in the risk of a cardiovascular event. In a multivariable model with patients having controlled hypertension (normal home and office BP) as the referent, the hazard ratio of cardiovascular events was 1.96 (95% CI, 1.27-3.02) in patients with uncontrolled hypertension (high BP with both measurement methods), 2.06 (95% CI, 1.22-3.47) in patients with normal office BP and elevated home BP, and 1.18 (95% CI, 0.67-2.10) in patients with elevated office BP and normal home BP.
Our findings suggest that home BP measurement has a better prognostic accuracy than office BP measurement. Blood pressure should systematically be measured at home in patients receiving treatment for hypertension.
在临床医生办公室使用汞柱式血压计测量血压存在诸多缺点。相比之下，家庭血压测量可提高测量精度和可重复性。然而，关于其预后价值的数据尚缺乏。
评估欧洲老年高血压患者中，家庭血压测量与诊室血压测量相比的预后价值。
设计、地点和参与者：在一个由4939例接受治疗的高血压患者组成的队列中，于基线时测量诊室血压、家庭血压及心脏危险因素（平均年龄70[标准差，6.5]岁；48.9%为男性），这些患者由其常规全科医生招募并随访，且在管理方面未给出具体建议。随后对该队列进行了平均3.2（标准差，0.5）年的随访。定义未控制高血压的阈值为诊室血压至少140/90mmHg，家庭血压至少135/85mmHg。
主要终点为心血管死亡率。次要终点为全因死亡率以及心血管死亡、非致死性心肌梗死、非致死性卒中、短暂性脑缺血发作、因心绞痛或心力衰竭住院、经皮腔内冠状动脉成形术或冠状动脉搭桥手术的综合情况。
随访结束时，99.9%的患者临床状态已知。324例（发生率为22.2/1000患者年）至少发生了1次心血管事件。对于家庭自测血压，收缩压每升高10mmHg，心血管事件风险增加17.2%（95%置信区间[CI]，11.0%-23.8%），舒张压每升高5mmHg，风险增加11.7%（95%CI，5.7%-18.1%）。相反，对于诊室测量观察到的相同血压升高，心血管事件风险无显著增加。在以血压得到控制（家庭和诊室血压均正常）的患者为参照的多变量模型中，血压未得到控制（两种测量方法血压均高）的患者发生心血管事件的风险比为1.96（95%CI，1.27-3.02），诊室血压正常但家庭血压升高的患者为2.06（95%CI，1.22-3.47），诊室血压升高但家庭血压正常的患者为1.18（95%CI，0.67-2.10）。
我们的研究结果表明，家庭血压测量比诊室血压测量具有更好的预后准确性。高血压患者应常规在家中测量血压。
