Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
Hypertension. 2011 Jun;57(6):1087-93. doi: 10.1161/HYPERTENSIONAHA.111.171645. Epub 2011 May 2.
The maximum office systolic blood pressure (SBP) has been shown to be a strong predictor of cardiovascular events, independently of the mean SBP level. However, the clinical implications of maximum home SBP have never been reported. We investigated the association between the maximum home SBP and target organ damage (TOD). We assessed the left ventricular mass index (LVMI) and carotid intima-media thickness (IMT) using ultrasonography and the urinary albumin/creatinine ratio (UACR) as measures of TOD in 356 never-treated hypertensive subjects. Home BP was taken in triplicate in the morning and evening, respectively, for 14 consecutive days with a memory-equipped device. The maximum home SBP was defined as the maximum mean triplicate BP reading in the 14-day period for each individual and was significantly correlated with LVMI (r=0.51, P<0.001), carotid IMT (r=0.40, P<0.001), and UACR (r=0.29, P<0.001). The correlation coefficients with LVMI and carotid IMT were significantly larger for the maximum home SBP than the mean home SBP. In multivariate regression analyses, the maximum home SBP was independently associated with LVMI and carotid IMT, regardless of the mean home BP level. In the prediction of left ventricular hypertrophy and carotid atherosclerosis, the goodness-of-fit of the model was significantly improved when the maximum home SBP was added to the sum of the mean office and home BPs (P=0.002 and P<0.001, respectively). These findings indicate that assessment of the maximum home SBP, in addition to the mean home SBP, might increase the predictive value of hypertensive TOD in the heart and artery.
最高诊室收缩压（SBP）已被证明是心血管事件的强有力预测因子，独立于平均 SBP 水平。然而，最高家庭 SBP 的临床意义从未被报道过。我们研究了最高家庭 SBP 与靶器官损害（TOD）之间的关系。我们使用超声心动图评估左心室质量指数（LVMI）和颈动脉内膜中层厚度（IMT），并使用尿白蛋白/肌酐比（UACR）作为 TOD 的指标，评估了 356 例未经治疗的高血压患者。使用具有记忆功能的设备，分别在早晨和晚上连续 14 天进行三次家庭 BP 测量。最高家庭 SBP 定义为每个人 14 天内的最大平均三次 BP 读数，并与 LVMI（r=0.51，P<0.001）、颈动脉 IMT（r=0.40，P<0.001）和 UACR（r=0.29，P<0.001）显著相关。最高家庭 SBP 与 LVMI 和颈动脉 IMT 的相关系数明显大于平均家庭 SBP。在多元回归分析中，最高家庭 SBP 与 LVMI 和颈动脉 IMT 独立相关，而与平均家庭 SBP 水平无关。在预测左心室肥厚和颈动脉粥样硬化时，当将最高家庭 SBP 添加到平均诊室和家庭 BP 的总和中时，模型的拟合优度显著提高（P=0.002 和 P<0.001）。这些发现表明，除了平均家庭 SBP 外，评估最高家庭 SBP 可能会增加高血压患者心脏和动脉 TOD 的预测价值。
