The Importance of Home Blood Pressure Measurement for Preventing Stroke and Cardiovascular Disease in Hypertensive Patients: A Sub-Analysis of the Japan Hypertension Evaluation with Angiotensin II Antagonist Losartan Therapy (J-HEALTH) Study, a Prospective Nationwide Observational Study
The Importance of Home Blood Pressure Measurement for Preventing Stroke and Cardiovascular Disease in Hypertensive Patients: A Sub-Analysis of the Japan Hypertension Evaluation with Angiotensin II Antagonist Losartan Therapy (J-HEALTH) Study, a Prospective Nationwide Observational Study
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DOI：
10.1291/hypres.31.1903
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发表时间：
2008-10-01
影响因子：
5.4
通讯作者：
Yoshiike, Nobuo
中科院分区：
文献类型：
--
作者：
Shimada, Kazuyuki;Fujita, Toshiro;Yoshiike, Nobuo
白大衣高血压（HT）和隐匿性高血压可以通过家庭血压（BP）测量来识别。在日本高血压患者中，这些亚型的患病率和相关的心血管疾病风险尚未得到充分调查。日本高血压评估血管紧张素II拮抗剂氯沙坦治疗（J-HEALTH）研究是一项全国性的前瞻性观察性研究，研究了接受治疗的日本高血压患者中HT引起的心血管事件的风险及其与家庭血压测量的关系。在治疗期间测量家庭和诊所血压，并监测4,596名日本患者（平均年龄60.8岁，43.2%为男性，平均随访时间3.5年）心血管事件的发生。治疗期间，高血压的定义是收缩压BP >=临床血压140 mmHg，家庭血压135 mmHg。所有心血管事件和卒中的相对风险随着治疗期间临床和家庭血压水平的升高而增加。白大衣热、隐匿热、控制良好热和控制不良热的患病率分别为12.6%、19.5%、23.8%和44.1%。与控制良好的HT亚组相比，控制不良的HT亚组（相对危险度[RR]: 2.05, 95%可信区间[CI]: 0.77-5.45）、白大衣HT亚组（FIR: 0.77, 95% CI: 0.15-3.96）和蒙面HT亚组（RR: 2.00, 95% CI: 0.67-5.98）心血管事件的相对危险度没有显著增加；然而，隐匿性HT的风险与控制不良的HT相似。监测临床和家庭血压对隐匿性HT的诊断和预防该亚型HT的心血管疾病很重要。然而，在接受治疗的日本患者中，需要进一步的调查来充分表征与隐蔽性HT相关的心血管风险。（Hypertens Res 2008; 31: 19031911）
White-coat hypertension (HT) and masked HT can be identified by home blood pressure (BP) measurement. The prevalence of these subtypes and the associated risk of cardiovascular disease have not been fully investigated among Japanese hypertensive patients. The risk of cardiovascular events due to HT and its relationship with home BP measurement were examined among Japanese hypertensive patients receiving treatment in the Japan Hypertension Evaluation with Angiotensin II Antagonist Losartan Therapy (J-HEALTH) study, a nationwide prospective observational study. Both home and clinic BP were measured during treatment, and the occurrence of cardiovascular events was monitored in 4,596 Japanese patients (mean age of 60.8 years, 43.2% men, and mean follow-up period of 3.5 years). HT was defined as a systolic BP BP >= 140 mmHg for clinic BP and 135 mmHg for home BP while on treatment. The relative risk of all cardiovascular events and stroke increased along with higher clinic and home BP levels during treatment. The prevalence of white-coat HT, masked HT, well-controlled HT, and poorly controlled HT was 12.6%, 19.5%, 23.8%, and 44.1%, respectively. The relative risk of cardiovascular events was not significantly increased in the poorly controlled HT (relative risk [RR]: 2.05, 95% confidence interval [CI]: 0.77-5.45), white-coat HT (FIR: 0.77, 95% CI: 0.15-3.96), and masked HT (RR: 2.00, 95% CI: 0.67-5.98) subgroups compared with the well-controlled-HT subgroup; however, the risk of masked HT was similar to that of poorly controlled HT. Monitoring both clinic and home BP is important to diagnose masked HT and to prevent cardiovascular disease in this subtype of HT. However, further investigation is required to fully characterize the cardiovascular risks associated with masked HT among Japanese patients receiving treatment. (Hypertens Res 2008; 31: 19031911)