Sakuma M, Imai Y, Tsuji I, Nagai K, Ohkubo T, Watanabe N, Sakuma H, Satoh H, Hisamichi S
Department of Environmental Health Sciences, Tohoku University School of Medicine, Sendai, Japan.
Hypertens Res. 1997 Sep;20(3):167-74. doi: 10.1291/hypres.20.167.
We investigated the utility of home blood pressure measurements for determining the risk of stroke. We also analyzed the relationship between home blood pressure and the incidence of stroke. Home blood pressure and screening blood pressure measurements were obtained from 1,789 residents (aged 40 yr or older) of a rural Japanese community. Blood pressure was measured at home with a semiautomatic device. A mean (+/-SD) of 23.0 +/- 7.5 measurements were made for each subject. Subjects without a history of stroke and who were not receiving medication for hypertension (n = 1,256) were prospectively followed up for 4.4 +/- 2.1 yr. Subjects were subdivided into quintiles according to their baseline blood pressure. The association between the baseline blood pressure and the incidence of the first-ever stroke was examined with the Cox proportional hazards regression model, adjusted for age and sex. The lowest risk of stroke morbidity occurred in the subjects in the third quintile for home systolic blood pressure (117-123 mmHg) and in those in the second quintile for home diastolic blood pressure (66-70 mmHg). The subjects in the fifth quintiles for home systolic (> or = 133 mmHg) and diastolic blood pressure (> or = 81 mmHg) had a significantly increased risk of stroke morbidity. The subjects in the first and the second quintiles for home systolic blood pressure and those in the first quintile for home diastolic blood pressure tended to have an increased risk as compared with subjects in the lowest risk groups, although this increase was not statistically significant, indicating two possibilities: a trend toward a J-shaped relationship or no-decrease in risk of the first-ever stroke in subjects with home blood pressure level less than 123/70 mmHg. This relationship was not observed for screening blood pressure. We conclude that home blood pressure measurements can provide additional prognostic information to that obtained from blood pressure measurement in a medical environment.
我们研究了家庭血压测量对于确定中风风险的效用。我们还分析了家庭血压与中风发病率之间的关系。从日本一个乡村社区的1789名居民（年龄在40岁及以上）中获取了家庭血压和筛查血压测量值。使用半自动设备在家中测量血压。每位受试者平均进行了23.0±7.5次测量。对没有中风病史且未接受高血压治疗的受试者（n = 1256）进行了为期4.4±2.1年的前瞻性随访。根据受试者的基线血压将其分为五个五分位数组。使用Cox比例风险回归模型，对年龄和性别进行校正后，检验基线血压与首次中风发病率之间的关联。家庭收缩压处于第三个五分位数组（117 - 123 mmHg）的受试者以及家庭舒张压处于第二个五分位数组（66 - 70 mmHg）的受试者中风发病风险最低。家庭收缩压处于第五个五分位数组（≥133 mmHg）和舒张压处于第五个五分位数组（≥81 mmHg）的受试者中风发病风险显著增加。与风险最低组的受试者相比，家庭收缩压处于第一个和第二个五分位数组的受试者以及家庭舒张压处于第一个五分位数组的受试者中风发病风险有增加趋势，尽管这种增加无统计学意义，这表明存在两种可能性：呈J形关系的趋势，或者家庭血压水平低于123/70 mmHg的受试者首次中风风险没有降低。对于筛查血压未观察到这种关系。我们得出结论，家庭血压测量可以为从医疗环境中的血压测量所获得的信息提供额外的预后信息。
