Ohkubo Takayoshi, Kikuya Masahiro, Asayama Kei, Metoki Hirohito, Hara Azusa, Inoue Ryusuke, Obara Taku, Hirose Takuo, Hatanaka Rieko, Hozawa Atsushi, Hoshi Haruhisa, Hashimoto Junichiro, Totsune Kazuhito, Satoh Hiroshi, Imai Yutaka
Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan.
Blood Press Monit. 2007 Dec;12(6):407-9. doi: 10.1097/MBP.0b013e328244e8a7.
Recent guidelines for the treatment of hypertension have all emphasized the importance of self-blood pressure (BP) measurements at home (home BP) in clinical applications of practice, research, and epidemiology. In the Ohasama study, a cohort study based on home BP, we have demonstrated several important findings to be incorporated in those guidelines. We demonstrated that home BP more accurately and reliably reflect target organ damage and the prognosis of cardiovascular disease than conventional BP, whereas the predictive value of home BP increased progressively with the number of measurements. Even the initial-first home BP values (one measurement) showed a significantly greater relation with stroke risk than conventional BP values (mean of two measurements). Home BP in the morning (morning BP) and in the evening (evening BP) provide equally useful information for stroke risk, whereas morning hypertension, which is that specifically observed only in the morning, might be a good predicator of stroke, particularly among individuals using anti-hypertensive medication. Home BP increased the predictive power of categorizations of guidelines compared with conventional BP. Heart rate values assessed at home using a device designed for home BP measurement (home heart rate) was significantly associated with the risk of cardiovascular mortality, independent of home BP. We expect that continuous follow-up and further analysis of the Ohasama data would contribute to producing further important findings worth incorporating in future hypertension guidelines.
近期的高血压治疗指南均强调了家庭自测血压（家庭血压）在临床实践、研究及流行病学应用中的重要性。在一项基于家庭血压的队列研究——大岛研究中，我们已证实了一些重要发现，可供纳入这些指南。我们证明，与传统血压相比，家庭血压能更准确、可靠地反映靶器官损害及心血管疾病的预后，而且家庭血压的预测价值会随着测量次数的增加而逐步提高。即便最初的首次家庭血压值（单次测量）与中风风险的关联也显著大于传统血压值（两次测量的平均值）。早晨的家庭血压（晨压）和晚上的家庭血压（晚压）对中风风险提供同样有用的信息，而仅在早晨出现的晨高血压可能是中风的良好预测指标，尤其是在服用抗高血压药物的个体中。与传统血压相比，家庭血压提高了指南分类的预测能力。使用专为家庭血压测量设计的设备在家中评估的心率值（家庭心率）与心血管死亡风险显著相关，且独立于家庭血压。我们预计，对大岛研究数据的持续随访和进一步分析将有助于得出更多值得纳入未来高血压指南的重要发现。
