与治疗前早晨家庭血压和诊室血压以及治疗期随访期间家庭血压相比,傍晚家庭血压的预测能力:HOMED-BP研究的事后分析

Predictive power of home blood pressure in the evening compared with home blood pressure in the morning and office blood pressure before treatment and in the on-treatment follow-up period: a post hoc analysis of the HOMED-BP study.

作者信息

Uchida Shinya, Kikuya Masahiro, Asayama Kei, Ohata Chiaki, Kimura Takahiro, Tatsumi Yukako, Nomura Kyoko, Imai Yutaka, Ohkubo Takayoshi

机构信息

Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.

Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.

出版信息

Hypertens Res. 2022 Apr;45(4):722-729. doi: 10.1038/s41440-022-00860-0. Epub 2022 Feb 17.

Abstract

The predictive power of home blood pressure (BP) in the evening compared with home BP in the morning and office BP has been controversial. The predictive power of evening BP was compared to that of morning BP and office BP. The likelihood ratio test between one model containing a single BP index with traditional risk factors and a similar model further containing another BP index was used to assess whether the additional BP index significantly improved the adequacy of the model. Of 3266 patients with mild-to-moderate hypertension who were on antihypertensive medications (men 50.6%, age 59.5 ± 10.0 years), 58 experienced a major adverse cardiovascular event during a median follow-up of 7.1 years. The hazard ratios for a one standard deviation increment of evening home systolic/diastolic BP were 1.26 (0.98-1.62)/1.43 (1.09-1.88) in the baseline untreated period and 1.46 (1.17-1.81)/1.63 (1.26-2.11) during the on-treatment follow-up period. When evening BP at baseline and that during follow-up were included in the same model, only the latter significantly improved the prediction models (P = 0.006/0.005 for systolic/diastolic BP). Then, evening home BP vs. morning BP during follow-up was tested. The former did not improve the prediction models (P > 0.2), but the latter significantly improved the models (P ≤ 0.048). Similarly, when evening home BP and office BP during follow-up were analyzed, only the former significantly improved the prediction models (P ≤ 0.015). In conclusion, evening BP could be a more potent predictor than office BP, but it was inferior compared to morning BP in the treatment of mild-to-moderate hypertensive patients.

摘要

与早晨家庭血压及诊室血压相比,傍晚家庭血压的预测能力一直存在争议。将傍晚血压的预测能力与早晨血压和诊室血压的预测能力进行了比较。使用包含单一血压指标与传统危险因素的一个模型和另一个进一步包含另一血压指标的类似模型之间的似然比检验,来评估额外的血压指标是否显著改善了模型的充分性。在3266例接受抗高血压药物治疗的轻至中度高血压患者中(男性占50.6%,年龄59.5±10.0岁),在中位随访7.1年期间,58例发生了主要不良心血管事件。在基线未治疗期,傍晚家庭收缩压/舒张压每增加一个标准差的风险比分别为1.26(0.98 - 1.62)/1.43(1.09 - 1.88),在治疗随访期为1.46(1.17 - 1.81)/1.63(1.26 - 2.11)。当将基线时的傍晚血压和随访期间的傍晚血压纳入同一模型时,只有后者显著改善了预测模型(收缩压/舒张压的P值分别为0.006/0.005)。然后,对随访期间的傍晚家庭血压与早晨血压进行了比较。前者未改善预测模型(P>0.2),但后者显著改善了模型(P≤0.048)。同样,当分析随访期间的傍晚家庭血压和诊室血压时,只有前者显著改善了预测模型(P≤0.015)。总之,傍晚血压可能是比诊室血压更强有力的预测指标,但在治疗轻至中度高血压患者方面,它不如早晨血压。

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