Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan.
Am J Hypertens. 2010 May;23(5):508-14. doi: 10.1038/ajh.2010.15. Epub 2010 Feb 25.
Several observational studies have shown that treated hypertensives are characterized as having worse prognosis than nonhypertensives. However, there is little evidence based on home blood pressure (home BP) measurement. We compare the risk of stroke between untreated individuals and those taking antihypertensive medication based on home BP and casual-screening BP (casual BP) in the general population.
The study included 1,690 untreated and 700 treated subjects aged >or=35 years. We measured home BP and casual BP at the beginning of the study. The risk of first stroke was examined by using the Cox proportional hazards model.
During 11.9 years of follow-up, we observed 242 first-time stroke cases. Treated subjects had significantly higher risk for stroke than untreated subjects based on home BP (relative hazard (RH) = 1.48) as well as on casual BP (RH = 1.78), adjusted for systolic BP values and characteristics. When subjects were classified into six categories based on BP (optimal, normal, high normal, and grade 1-3 hypertension), RHs in treated hypertensives linearly increased (trend P < 0.01) based on home BP. However, there was no consistent association for casual BP (trend P: not significant) in treated subjects. Stroke risk was linearly increased regardless of the BP information source in untreated subjects (home BP: trend P < 0.01, casual BP: trend P < 0.01).
The results suggest a strong association between elevated home BP and increased risk of stroke. Home BP is a better tool to assess stroke risk, especially in treated hypertensives.
多项观察性研究表明，接受治疗的高血压患者的预后比未接受治疗的高血压患者更差。然而，基于家庭血压（home BP）测量的证据很少。我们比较了未经治疗的个体和服用降压药物的个体（基于家庭 BP 和偶然筛查 BP（casual BP））在一般人群中的中风风险。
该研究纳入了 1690 名未经治疗和 700 名接受治疗的年龄≥35 岁的患者。我们在研究开始时测量了家庭 BP 和偶然 BP。使用 Cox 比例风险模型检查首次中风的风险。
在 11.9 年的随访期间，我们观察到 242 例首次中风病例。接受治疗的患者与未经治疗的患者相比，基于家庭 BP（相对危险度（RH）=1.48）和偶然 BP（RH=1.78），调整了收缩压值和特征，发生中风的风险明显更高。当根据 BP（最佳、正常、高正常和 1-3 级高血压）将患者分为六个类别时，基于家庭 BP 的治疗性高血压患者的 RH 呈线性增加（趋势 P<0.01）。然而，治疗组偶然 BP（趋势 P：无统计学意义）没有一致的关联。无论 BP 信息来源如何，未治疗患者的中风风险均呈线性增加（家庭 BP：趋势 P<0.01，偶然 BP：趋势 P<0.01）。
结果表明，家庭 BP 升高与中风风险增加之间存在很强的关联。家庭 BP 是评估中风风险的更好工具，尤其是在治疗性高血压患者中。
