Morning and Evening Home Blood Pressure and Risks of Incident Stroke and Coronary Artery Disease in the Japanese General Practice Population The Japan Morning Surge-Home Blood Pressure Study
Morning and Evening Home Blood Pressure and Risks of Incident Stroke and Coronary Artery Disease in the Japanese General Practice Population The Japan Morning Surge-Home Blood Pressure Study
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DOI：
10.1161/hypertensionaha.116.07201
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发表时间：
2016-07-01
期刊：
影响因子：
8.3
通讯作者：
Kario, Kazuomi
中科院分区：
文献类型：
--
作者：
Hoshide, Satoshi;Yano, Yuichiro;Kario, Kazuomi
我们的目的是确定家庭血压（BP）监测的最佳时间表，最好地预测中风和冠状动脉疾病的一般做法。日本晨峰-家庭血压（J-HOP）研究是一项全国性的基于实践的研究，包括4310名有心血管疾病病史或危险因素或两者兼而有之的日本人（平均年龄65岁; 79%使用降压药物）。在基线时，在14天内每天两次（早晨和晚上）进行家庭血压测量。在平均4年（16929人年）的随访期间，发生了74例卒中和77例冠状动脉疾病事件。早晨收缩压（SBP）改善了卒中事件的区分度（C统计量，0.802; 95%置信区间，0.692-0.911），超过了传统的危险因素，包括办公室SBP（0.756; 0.646-0.866），而夜间SBP的变化较小（0.764; 0.653-0.874）。在模型中增加夜间SBP（包括传统危险因素加早晨SBP）显著降低了卒中事件的区分度（C统计学差异，-0.008; 95%置信区间：-0.015至-0.008; P=0.03）。无类别净重新分类改善（0.3606; 95%置信区间，0.1317-0.5896）、绝对综合辨别力改善（0.015; SE，0.005）和相对综合辨别力改善（58.3%;所有P
Our aim is to determine the optimal time schedule for home blood pressure (BP) monitoring that best predicts stroke and coronary artery disease in general practice. The Japan Morning Surge-Home Blood Pressure (J-HOP) study is a nationwide practice-based study that included 4310 Japanese with a history of or risk factors for cardiovascular disease, or both (mean age, 65 years; 79% used antihypertensive medication). Home BP measures were taken twice daily (morning and evening) over 14 days at baseline. During a mean follow-up of 4 years (16 929 person-years), 74 stroke and 77 coronary artery disease events occurred. Morning systolic BP (SBP) improved the discrimination of incident stroke (C statistics, 0.802; 95% confidence interval, 0.692-0.911) beyond traditional risk factors including office SBP (0.756; 0.646-0.866), whereas the changes were smaller with evening SBP (0.764; 0.653-0.874). The addition of evening SBP to the model (including traditional risk factors plus morning SBP) significantly reduced the discrimination of incident stroke (C statistics difference, -0.008; 95% confidence interval: -0.015 to -0.008; P=0.03). The category-free net reclassification improvement (0.3606; 95% confidence interval, 0.1317-0.5896), absolute integrated discrimination improvement (0.015; SE, 0.005), and relative integrated discrimination improvement (58.3%; all P