Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
Hypertens Res. 2022 Jan;45(1):75-86. doi: 10.1038/s41440-021-00757-4. Epub 2021 Oct 17.
In diagnosis of treatment-resistant hypertension (TRH), guidelines recommend out-of-office blood pressure (BP) measurements, ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM). Although evidence of an association between ABPM-evaluated TRH and cardiovascular disease (CVD) prognosis has accumulated, data are sparse regarding HBPM-evaluated TRH. We investigated this issue using data from the nationwide practice-based J-HOP (Japan Morning-Surge Home BP) study, which recruited 4,261 outpatients (mean age 64.9 years; 46.8% men; 91.5% hypertensives) who underwent morning and evening HBPM for 14 days. During 6.2 ± 3.8 years (26,418 person-years) follow-up, 270 total CVDs (stroke, coronary artery disease, aortic dissection, and heart failure) occurred. The adjusted hazard ratio (HR) (95% CIs) of uncontrolled TRH, i.e., uncontrolled BP using 3 classes of medications including diuretics or ≥4 classes of medications, for total CVD risk compared to controlled BP using <3 classes were 2.02 (1.38-2.94) and 1.81 (1.23-2.65) in home BP of 135/85 mmHg and 130/80 mmHg, respectively. Additionally, patients with TRH defined by guidelines, i.e., uncontrolled BP using 3 classes of medications including diuretics or controlled/uncontrolled BP using ≥4 classes of medications, also had higher total CVD risk compared to non-TRH under all home BP criteria. Moreover, in patients with uncontrolled apparent-TRH, i.e., TRH defined by office BP, uncontrolled home BP (≥135/85 mmHg) was still associated with atherosclerotic CVD (CVDs except heart failure) risk (adjusted HR [95% CI], 2.38 [1.09-5.19]). This is the first study to demonstrate an independent association between TRH evaluated by HBPM and CVD outcomes.
在治疗抵抗性高血压（TRH）的诊断中，指南建议进行诊室外血压（BP）测量、动态血压监测（ABPM）和家庭血压监测（HBPM）。尽管已经积累了 ABPM 评估的 TRH 与心血管疾病（CVD）预后之间关联的证据，但关于 HBPM 评估的 TRH 的数据仍然很少。我们使用全国范围内基于实践的 J-HOP（日本清晨血压家庭监测）研究的数据来研究这个问题，该研究共招募了 4261 名门诊患者（平均年龄 64.9 岁；46.8%为男性；91.5%为高血压患者），他们进行了为期 14 天的清晨和傍晚 HBPM。在 6.2±3.8 年（26418 人年）的随访中，共发生了 270 例总 CVD（中风、冠心病、主动脉夹层和心力衰竭）。与使用<3 类药物控制血压相比，使用 3 类药物（包括利尿剂）或≥4 类药物控制血压时，HBPM 为 135/85mmHg 和 130/80mmHg 时，未控制的 TRH（即使用 3 类药物控制血压，包括利尿剂或使用≥4 类药物控制血压）的调整后的 HR（95%CI）分别为 2.02（1.38-2.94）和 1.81（1.23-2.65）。此外，根据指南定义的 TRH 患者，即使用 3 类药物（包括利尿剂）或使用≥4 类药物控制血压时，与非 TRH 患者相比，所有 HBPM 标准下的总 CVD 风险均较高。此外，在未控制的明显 TRH 患者中，即办公室 BP 定义的 TRH，未控制的家庭 BP（≥135/85mmHg）与动脉粥样硬化性 CVD（除心力衰竭外的 CVD）风险仍然相关（调整后的 HR[95%CI]，2.38[1.09-5.19]）。这是第一项表明 HBPM 评估的 TRH 与 CVD 结局之间存在独立关联的研究。
