Stroke Risk in Treated Hypertension Based on Home Blood Pressure: the Ohasama Study
Stroke Risk in Treated Hypertension Based on Home Blood Pressure: the Ohasama Study
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DOI：
10.1038/ajh.2010.15
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发表时间：
2010-05-01
影响因子：
3.2
通讯作者：
Imai, Yutaka
中科院分区：
文献类型：
--
作者：
Yasui, Daisaku;Asayama, Kei;Imai, Yutaka
研究背景几项观察性研究表明，治疗后的高血压患者的预后比非高血压患者差。然而，很少有基于家庭血压（家庭BP）测量的证据。我们比较了未治疗的个体和那些服用抗高血压药物的基础上家庭BP和医院筛查BP（偶然BP）在一般population. METHODS研究包括1,690未经治疗和700治疗的受试者年龄岁之间的中风的风险。我们在研究开始时测量了家庭BP和临时BP。首次中风的风险采用考克斯比例风险模型进行分析。在11.9年的随访中，我们观察了242例首次中风病例。根据家庭血压（相对危险度（RH）= 1.48）和偶然血压（RH = 1.78）（根据收缩压值和特征进行调整），接受治疗的受试者的中风风险明显高于未经治疗的受试者。当受试者根据血压分为6类（最佳、正常、正常高值和1-3级高血压）时，接受治疗的高血压患者的RH基于家庭血压线性增加（趋势P < 0.01）。然而，在接受治疗的受试者中，偶然BP没有一致的相关性（趋势P：不显著）。在未经治疗的受试者中，无论BP信息来源如何，卒中风险均呈线性增加（家庭BP：趋势P <0.01，偶然BP：趋势P < 0.01）。家庭血压是评估中风风险的更好工具，特别是在治疗的高血压患者中。
BACKGROUNDSeveral observational studies have shown that treated hypertensives are characterized as having worse prognosis than nonhypertensives. However, there is little evidence based on home blood pressure (home BP) measurement. We compare the risk of stroke between untreated individuals and those taking antihypertensive medication based on home BP and casual-screening BP (casual BP) in the general population.METHODSThe study included 1,690 untreated and 700 treated subjects aged years. We measured home BP and casual BP at the beginning of the study. The risk of first stroke was examined by using the Cox proportional hazards model.RESULTSDuring 11.9 years of follow-up, we observed 242 first-time stroke cases. Treated subjects had significantly higher risk for stroke than untreated subjects based on home BP (relative hazard (RH) = 1.48) as well as on casual BP (RH = 1.78), adjusted for systolic BP values and characteristics. When subjects were classified into six categories based on BP (optimal, normal, high normal, and grade 1-3 hypertension), RHs in treated hypertensives linearly increased (trend P < 0.01) based on home BP. However, there was no consistent association for casual BP (trend P: not significant) in treated subjects. Stroke risk was linearly increased regardless of the BP information source in untreated subjects (home BP: trend P < 0.01, casual BP: trend P < 0.01).CONCLUSIONThe results suggest a strong association between elevated home BP and increased risk of stroke. Home BP is a better tool to assess stroke risk, especially in treated hypertensives.