Division of Cardiology, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
Keio University, Kanagawa, Japan.
J Am Coll Cardiol. 2016 Apr 5;67(13):1519-1527. doi: 10.1016/j.jacc.2016.01.037.
Few studies have evaluated out-of-office blood pressure (BP) measurements as predictors of coronary artery disease (CAD) events.
The aim of this study was to determine morning home blood pressure (HBP) as a predictor of CAD events.
Using data from the HONEST (Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure) study, we investigated the relationship between morning HBP and incidence of stroke and CAD events.
In 21,591 treated hypertensive patients (mean age 64.9 years; mean follow-up 2.02 years), 127 stroke events (2.92 per 1,000 patient-years), and 121 CAD events (2.78 per 1,000 patient-years) occurred. The incidence of stroke events was significantly higher in patients with morning home systolic blood pressure (HSBP) ≥145 mm Hg compared with <125 mm Hg, and in patients with clinic systolic blood pressure (CSBP) ≥150 mm Hg compared with <130 mm Hg. Hazard ratios (HRs) were 6.01 (95% confidence interval [CI]: 2.85 to 12.68) between patients with morning HSBP ≥155 mm Hg and those with morning HSBP <125 mm Hg and 5.82 (95% CI: 3.17 to 10.67) between patients with CSBP ≥160 mm Hg and those with CSBP <130 mm Hg; morning HSBP predicted stroke events similarly to CSBP. Incidence of CAD events was significantly higher in patients with morning HSBP ≥145 mm Hg compared with <125 mm Hg and in patients with CSBP ≥160 mm Hg compared with <130 mm Hg. The HR for morning HSBP ≥155 mm Hg was 6.24 (95% CI: 2.82 to 13.84) and for CSBP ≥160 mm Hg was 3.51 (95% CI: 1.71 to 7.20); therefore, compared with morning HSBP, CSBP may underestimate CAD risk. Goodness-of-fit analysis showed that morning HSBP predicted CAD events more strongly than CSBP.
Morning HBP is a strong predictor of future CAD and stroke events, and may be superior to clinic BP in this regard. There does not appear to be a J-curve in the relationship between morning HBP and stroke or CAD events. (Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure Study [HONEST]; UMIN000002567).
很少有研究评估非诊室血压（BP）测量作为冠心病（CAD）事件的预测指标。
本研究旨在确定清晨家庭血压（HBP）作为 CAD 事件的预测指标。
利用来自 HONEST（使用奥美沙坦治疗的患者进行家庭血压测量以建立标准靶血压）研究的数据，我们研究了清晨 HBP 与卒中和 CAD 事件发生率之间的关系。
在 21591 例接受治疗的高血压患者（平均年龄 64.9 岁；平均随访 2.02 年）中，发生了 127 例卒中事件（每 1000 例患者年 2.92 例）和 121 例 CAD 事件（每 1000 例患者年 2.78 例）。与清晨 HBP<125mmHg 的患者相比，清晨 HBP≥145mmHg 的患者卒中事件发生率明显更高，与清晨诊室收缩压（CSBP）<130mmHg 的患者相比，CSBP≥150mmHg 的患者卒中事件发生率明显更高。与清晨 HBP<125mmHg 的患者相比，清晨 HBP≥155mmHg 的患者发生卒中事件的风险比（HR）为 6.01（95%置信区间[CI]：2.85 至 12.68），与 CSBP<130mmHg 的患者相比，CSBP≥160mmHg 的患者发生卒中事件的 HR 为 5.82（95%CI：3.17 至 10.67）；清晨 HBP 预测卒中事件的作用与 CSBP 相似。与清晨 HBP<125mmHg 的患者相比，清晨 HBP≥145mmHg 的患者 CAD 事件发生率明显更高，与清晨 CSBP<130mmHg 的患者相比，CSBP≥160mmHg 的患者 CAD 事件发生率明显更高。清晨 HBP≥155mmHg 的 HR 为 6.24（95%CI：2.82 至 13.84），CSBP≥160mmHg 的 HR 为 3.51（95%CI：1.71 至 7.20）；因此，与清晨 HBP 相比，CSBP 可能低估了 CAD 风险。拟合优度分析表明，清晨 HBP 预测 CAD 事件的能力强于 CSBP。
清晨 HBP 是未来 CAD 和卒中事件的有力预测指标，在这方面可能优于诊室 BP。清晨 HBP 与卒中或 CAD 事件之间的关系似乎没有 J 曲线。（使用奥美沙坦治疗的患者进行家庭血压测量以建立标准靶血压研究[HONEST]；UMIN000002567）。
