Nakayama Shingo, Satoh Michihiro, Metoki Hirohito, Murakami Takahisa, Tatsumi Yukako, Asayama Kei, Hara Azusa, Hirose Takuo, Tsubota-Utsugi Megumi, Kikuya Masahiro, Mori Takefumi, Hozawa Atsushi, Imai Yutaka, Ohkubo Takayoshi
Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
Am J Hypertens. 2023 Feb 24;36(3):151-158. doi: 10.1093/ajh/hpac121.
We investigated the association between ambulatory blood pressure (BP) and the risk of home hypertension in a normotensive population and whether considering ambulatory BP improves the 10-year prediction model for home hypertension risk, which was developed in the previous Ohasama Study.
In this prospective study, we followed up with 410 participants (83.2% women; age, 53.6 years) without a home and ambulatory hypertension in the general population of Ohasama, Japan. The Cox model was used to assess the hazard ratios (HRs) for home hypertension (home BP ≥ 135/≥85 mmHg or the initiation of antihypertensive treatment) and model improvement.
During a mean 14.2-year follow-up, 225 home hypertension incidences occurred. The HR (95% confidence interval) for home hypertension incidence per 1-SD higher (=6.76 mmHg) 24-hour systolic BP (SBP) was 1.59 (1.33 to 1.90), after adjustments for possible confounding factors, including baseline home SBP. Harrell's C-statistics increased from 0.72 to 0.73 (P = 0.11) when 24-hour SBP was added to the basic 10-year home hypertension prediction model, which includes sex, age, body mass index, smoking status, office SBP, and baseline home SBP. Continuous net reclassification improvement (0.53, P < 0.0001) and integrated discrimination improvement (0.028, P = 0.0014) revealed improvement in the model.
A total of 24-hour SBP could be an independent predictor of future home hypertension. Home BP and 24-hour BP can longitudinally influence each other in the long term.
我们在血压正常人群中研究了动态血压（BP）与家庭高血压风险之间的关联，以及纳入动态血压是否能改善先前大崎研究中建立的家庭高血压风险10年预测模型。
在这项前瞻性研究中，我们对日本大崎普通人群中410名无家庭高血压和动态高血压的参与者（83.2%为女性；年龄53.6岁）进行了随访。采用Cox模型评估家庭高血压（家庭血压≥135/≥85 mmHg或开始降压治疗）的风险比（HRs）及模型改善情况。
在平均14.2年的随访期间，发生了225例家庭高血压事件。在调整包括基线家庭收缩压在内的可能混杂因素后，24小时收缩压（SBP）每升高1个标准差（=6.76 mmHg），家庭高血压发生率的HR（95%置信区间）为1.59（1.33至1.90）。当将24小时SBP添加到包括性别、年龄、体重指数、吸烟状况、诊室SBP和基线家庭SBP的基本10年家庭高血压预测模型中时，Harrell's C统计量从0.72增加到0.73（P = 0.11）。连续净重新分类改善（0.53，P < 0.0001）和综合判别改善（0.028，P = 0.0014）显示模型有所改善。
24小时SBP可能是未来家庭高血压的独立预测因素。家庭血压和24小时血压在长期内可能会相互纵向影响。
