Fagard R H, Van Den Broeke C, De Cort P
Department of Molecular and Cardiovascular Research, Hypertension and Cardiovascular Rehabilitation Unit, Faculty of Medicine, University of Leuven, UZ Gasthuisberg, Leuven, Belgium.
J Hum Hypertens. 2005 Oct;19(10):801-7. doi: 10.1038/sj.jhh.1001903.
The purpose of the study was to assess the prognostic significance of out-of-the-office blood pressure (BP) measurement in older patients in general practice, and to compare the results for BP measured in the office, at home and during 24-h ambulatory monitoring. All registerd patients who were 60 years or older were eligible for the study, except when bedridden, demented or admitted in a home for sick elderly people, or when they had suffered a myocardial infarction or stroke. After baseline measurements in 1990-1993, incidence of major cardiovascular events (cardiovascular death, myocardial infarction and stroke) was ascertained in 2002-2003 and related to the BPs by use of multivariate Cox regression analysis. Age of the 391 patients averaged 71+/-9 years; 40% were men. During median follow-up of 10.9 years, 86 patients (22%) suffered a cardiovascular event. The adjusted relative hazard rate, associated with a 1 s.d. increment in systolic BP was 1.13 for office BP (NS), and, respectively, 1.32, 1.33 and 1.42, for home, daytime and night time BP (P< or =0.01 for all). Results were similar for diastolic BP. The prognostic significance of all out-of-the-office BPs was independent of office BP. The prognostic value of home BP was equal to (systolic) or even better (diastolic) than that of daytime BP. Night time BP predicted cardiovascular events independent of all other BPs. Prognosis of white-coat hypertension was similar to that of true normotension, but better than in sustained hypertension. In conclusion, the prognostic value of home BP is better than that of office BP in older patients in primary care, and is at least equal to that of daytime ambulatory BP. The prognosis of patients with white-coat hypertension is similar to that of true normotensives.
该研究的目的是评估非诊室血压测量在老年患者全科医疗中的预后意义，并比较诊室测量血压、家庭测量血压和24小时动态血压监测的结果。所有登记的60岁及以上患者均符合研究条件，但卧床不起、患有痴呆症、入住老年病院或曾发生心肌梗死或中风的患者除外。在1990 - 1993年进行基线测量后，于2002 - 2003年确定主要心血管事件（心血管死亡、心肌梗死和中风）的发生率，并通过多变量Cox回归分析将其与血压相关联。391例患者的年龄平均为71±9岁；40%为男性。在中位随访10.9年期间，86例患者（22%）发生了心血管事件。收缩压每增加1个标准差，诊室血压的调整后相对风险率为1.13（无统计学意义），而家庭血压、日间血压和夜间血压分别为1.32、1.33和1.42（均P≤0.01）。舒张压的结果相似。所有非诊室血压的预后意义均独立于诊室血压。家庭血压的预后价值在收缩压方面等于或（在舒张压方面）甚至优于日间血压。夜间血压独立于所有其他血压预测心血管事件。白大衣高血压的预后与真正的血压正常者相似，但优于持续性高血压。总之，在初级保健中，老年患者家庭血压的预后价值优于诊室血压，且至少等于日间动态血压。白大衣高血压患者的预后与真正血压正常者相似。
