Shimizu Motohiro, Hoshide Satoshi, Ishikawa Joji, Yano Yuichiro, Eguchi Kazuo, Kario Kazuomi
Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan;
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
Am J Hypertens. 2015 Aug;28(8):980-6. doi: 10.1093/ajh/hpu250. Epub 2014 Dec 29.
Some previous studies have shown that central blood pressure (BP) is more closely related to cardiovascular risks than brachial BP. This study compared the correlations between asymptomatic organ damages and each of central BP, brachial clinic BP, and home BP during antihypertensive treatment.
In the Japan Morning Surge-Target Organ Protection (J-TOP) study, which compared bedtime or awakening dosing of candesartan (+diuretics as needed) among subjects with home systolic BP (SBP) higher than 135 mm Hg, we evaluated 180 hypertensive patients who successfully underwent pulse wave analysis by HEM-9000AI and measured their urinary albumin/creatinine ratio (UACR) and left ventricular mass index (LVMI) (n = 144) at baseline and after 6 months of treatment.
During antihypertensive treatment, significant reductions were found in central SBP, UACR, and LVMI (all P < 0.001). Multiple regression analyses showed that the decrease in central SBP was associated with those of log-transformed UACR (β = 0.24, P < 0.01) and LVMI (β = 0.23, P = 0.04), independently of the decrease in both clinic and home SBP. The goodness-of-fit of the association between the reduction in SBP and the UACR (P < 0.01) or LVMI (P = 0.04) was improved by adding central SBP to the SBP measurement.
These findings suggest that the change in central BP could be an important therapeutic target during antihypertensive treatment, in addition to peripheral clinic and home BP.
既往一些研究表明，中心血压（BP）比肱动脉血压与心血管风险的关系更为密切。本研究比较了降压治疗期间无症状器官损害与中心血压、诊室肱动脉血压及家庭血压之间的相关性。
在日本清晨血压波动-靶器官保护（J-TOP）研究中，该研究比较了在家收缩压（SBP）高于135 mmHg的受试者中坎地沙坦（按需加用利尿剂）睡前或晨起给药的情况，我们评估了180例成功接受HEM-9000AI脉搏波分析的高血压患者，并在基线及治疗6个月后测量了他们的尿白蛋白/肌酐比值（UACR）和左心室质量指数（LVMI）（n = 144）。
在降压治疗期间，中心SBP、UACR和LVMI均显著降低（均P < 0.001）。多元回归分析显示，中心SBP的降低与对数转换后的UACR（β = 0.24，P < 0.01）和LVMI（β = 0.23，P = 0.04）的降低相关，独立于诊室和家庭SBP的降低。将中心SBP纳入SBP测量后，SBP降低与UACR（P < 0.01）或LVMI（P = 0.04）之间关联的拟合优度得到改善。
这些发现表明，除了外周诊室血压和家庭血压外，中心血压的变化可能是降压治疗期间一个重要的治疗靶点。
