Ohkubo T, Imai Y, Tsuji I, Nagai K, Ito S, Satoh H, Hisamichi S
Department of Public Health, Tohoku University School of Medicine, Sendai, Japan.
Hypertension. 1998 Aug;32(2):255-9. doi: 10.1161/01.hyp.32.2.255.
Although reference values for ambulatory blood pressure (ABP) monitoring have been investigated in several population studies, these values were derived from cross-sectional observations and were based merely on the statistical distribution of blood pressure values. Therefore, we conducted a prospective cohort study to identify reference values for 24-hour ABP in relation to prognosis. We obtained measurements of 24-hour ABP for 1542 subjects (565 men) aged 40 years and over in a general population of a rural Japanese community and then followed-up their survival status. There were 117 deaths during the follow-up period (mean, 6.2 years). The association between baseline 24-hour ABP values and mortality, examined by the Cox proportional hazards regression model adjusted for possible confounding factors, showed a better fit with a second-degree equation than with a first-degree equation. On the basis of the results of this analysis, we identified the following reference values as the optimal blood pressure ranges that predict the best prognosis: 120 to 133 mm Hg for systolic blood pressure and 65 to 78 mm Hg for diastolic blood pressure. 24-Hour ABP values >134/79 mm Hg and <119/64 mm Hg were related to increased risks for cardiovascular and noncardiovascular mortality, respectively. This is the first report to propose reference values for 24-hour ABP based on a prognostic criterion.
尽管在多项人群研究中已对动态血压（ABP）监测的参考值进行了调查，但这些值是通过横断面观察得出的，仅仅基于血压值的统计分布。因此，我们进行了一项前瞻性队列研究，以确定与预后相关的24小时ABP参考值。我们在一个日本农村社区的普通人群中，对1542名年龄在40岁及以上的受试者（565名男性）进行了24小时ABP测量，然后跟踪他们的生存状况。随访期间有117人死亡（平均6.2年）。通过针对可能的混杂因素进行调整的Cox比例风险回归模型检查基线24小时ABP值与死亡率之间的关联，结果显示二次方程比一次方程拟合得更好。基于该分析结果，我们确定以下参考值为预测最佳预后的最佳血压范围：收缩压为120至133毫米汞柱，舒张压为65至78毫米汞柱。24小时ABP值>134/79毫米汞柱和<119/64毫米汞柱分别与心血管和非心血管死亡率增加相关。这是第一份基于预后标准提出24小时ABP参考值的报告。
