Ohata Chiaki, Asayama Kei, Hosaka Miki, Nomura Kyoko, Yamamura Tomoko, Kimura Takahiro, Tatsumi Yukako, Kikuya Masahiro, Shibata Shigeru, Imai Yutaka, Ohkubo Takayoshi
Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Hypertens Res. 2023 Oct;46(10):2400-2408. doi: 10.1038/s41440-023-01408-6. Epub 2023 Aug 17.
No studies examined sex differences in relation to the prognostic significance of self-measured home blood pressure (HBP). We compared the predictive power for the risk of cardiovascular events in 1547 women and 1516 men with hypertension using HBP captured at treatment-free baseline and during on-treatment follow-up, based on the Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP) study. To express the change in risk for the composite cardiovascular endpoint associated with a 1-SD increase in HBP at baseline or on treatment, we derived multivariable-adjusted hazard ratios (HR) based on a Cox regression model. Over a median follow-up of 7.3 years, 100 composite events occurred, including 40 events in women. In women, systolic HBP both at baseline and on-treatment showed significant risk increment (at baseline: HR per 1-SD increment, 1.62; 95% confidence interval [CI], 1.17-2.24. on-treatment: HR, 1.74; 95% CI, 1.32-2.29). However, systolic HBP at baseline did not predict cardiovascular events in men (P = 0.25). On-treatment HBP was significantly associated with cardiovascular risk (P ≤ 0.012) irrespective of sex. Nevertheless, the point estimate of HR for systolic HBP in men (1.33) was less than that in women (1.74), and the interaction of sex with 1 SD-increase in systolic HBP in cardiovascular risk was significant irrespective of baseline (P = 0.039) or follow-up (P = 0.040) measurement when they were mutually adjusted. The increase in cardiovascular risk with the systolic HBP was steeper in women than in men for both baseline and on-treatment. The current findings unveil the importance of the control of systolic HBP, especially in women. Clinical Trial Registration: UMIN Clinical Trial Registry ( http://www.umin.ac.jp/ctr ), Unique identifier: C000000137.
尚无研究探讨自测家庭血压（HBP）的预后意义方面的性别差异。基于血压电子设备测量的高血压客观治疗（HOMED-BP）研究，我们比较了1547名女性和1516名男性高血压患者使用治疗前基线和治疗期间随访时记录的HBP对心血管事件风险的预测能力。为了表达基线或治疗时HBP每增加1个标准差与复合心血管终点风险变化的关系，我们基于Cox回归模型得出多变量调整风险比（HR）。在中位随访7.3年期间，发生了100例复合事件，其中女性40例。在女性中，基线和治疗时的收缩压HBP均显示出显著的风险增加（基线时：每增加1个标准差的HR为1.62；95%置信区间[CI]，1.17 - 2.24。治疗时：HR为1.74；95%CI，1.32 - 2.29）。然而，基线时的收缩压HBP并不能预测男性的心血管事件（P = 0.25）。无论性别如何，治疗时的HBP与心血管风险显著相关（P≤0.012）。尽管如此，男性收缩压HBP的HR点估计值（1.33）低于女性（1.74），并且在相互调整时，收缩压HBP每增加1个标准差时性别与心血管风险的相互作用在基线（P = 0.039）或随访（P = 0.040）测量时均具有显著性。对于基线和治疗时，女性收缩压HBP导致的心血管风险增加比男性更陡峭。当前研究结果揭示了控制收缩压HBP的重要性，尤其是在女性中。临床试验注册：UMIN临床试验注册中心（http://www.umin.ac.jp/ctr），唯一标识符：C000000137。
