Asayama Kei, Ohkubo Takayoshi, Hara Azusa, Hirose Takuo, Yasui Daisaku, Obara Taku, Metoki Hirohito, Inoue Ryusuke, Kikuya Masahiro, Totsune Kazuhito, Hoshi Haruhisa, Satoh Hiroshi, Imai Yutaka
Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University 21st Century COE Program, Aoba-ku, Sendai, Japan.
Blood Press Monit. 2009 Jun;14(3):93-8. doi: 10.1097/MBP.0b013e32832a9d91.
To compare the predictive power of home blood pressure (HBP) measured in the evening (E-HBP) and that of casual screening BP (CBP) for stroke risk in relation to the number of E-HBP measurements.
We obtained E-HBP (measured once in the evening just before going to bed for 4 weeks) and CBP (measured twice during the health checkup) from 2234 Japanese participants aged >or=35 years who had no history of a previous stroke. The participants were followed-up for a median duration of 11.9 years. The multivariate adjusted relative hazard (RH) and 95% confidence intervals (CI) for each 10 mmHg (systolic) or 5 mmHg (diastolic) increase in BP was determined by Cox regression model.
There were 226 incidences of stroke. Even the initial E-HBP values significantly predicted future stroke events (systolic RH=1.19, 95% CI=1.11-1.28; diastolic RH=1.12, 95% CI=1.06-1.19), and the predictive power of E-HBP increased progressively with the increased number of measurements. When initial systolic E-HBP and systolic CBP values were simultaneously included into the Cox model, only initial E-HBP was significantly related with stroke risk (E-HBP RH=1.17, 95% CI=1.08-1.26; CBP RH=1.07, 95% CI=0.99-1.15).
E-HBP has a stronger predictive power than CBP regardless of the number of measurements. Our findings emphasize the important clinical significance of E-HBP over CBP, even though the measurement conditions of E-HBP are generally less strict than that of morning HBP measurements.
比较晚间家庭血压（E-HBP）与偶测血压（CBP）对卒中风险的预测能力，并探讨其与E-HBP测量次数的关系。
我们收集了2234名年龄≥35岁、既往无卒中病史的日本参与者的E-HBP（连续4周每晚睡前测量一次）和CBP（健康体检时测量两次）数据。对参与者进行了为期11.9年的中位随访。采用Cox回归模型确定血压每升高10 mmHg（收缩压）或5 mmHg（舒张压）时的多变量调整相对危险度（RH）及95%置信区间（CI）。
共发生226例卒中事件。即使是初始E-HBP值也能显著预测未来卒中事件（收缩压RH=1.19，95%CI=1.11-1.28；舒张压RH=1.12，95%CI=1.06-1.19），且E-HBP的预测能力随测量次数的增加而逐渐增强。当将初始收缩压E-HBP和收缩压CBP值同时纳入Cox模型时，只有初始E-HBP与卒中风险显著相关（E-HBP RH=1.17，95%CI=1.08-1.26；CBP RH=1.07，95%CI=0.99-1.15）。
无论测量次数多少，E-HBP的预测能力均强于CBP。我们的研究结果强调了E-HBP相对于CBP的重要临床意义，尽管E-HBP的测量条件通常不如早晨家庭血压测量严格。
