Home blood pressure predicts stroke incidence among older adults with impaired physical function: the Ohasama study.
Home blood pressure predicts stroke incidence among older adults with impaired physical function: the Ohasama study.
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家庭血压可预测身体机能受损的老年人中风的发生率：Ohasama 研究。
DOI：
10.1097/hjh.0000000000001473
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Ohkubo T.
中科院分区：
文献类型：
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作者：
Murakami K;Asayama K;Satoh M;Hosaka M;Matsuda A;Inoue R;Tsubota-Utsugi M;Murakami T;Nomura K;Kikuya M;Metoki H;Imai Y;Ohkubo T.
目的：几项观察性研究发现，功能状态对常规办公室血压（BP）和不良结局之间的关联具有调节作用。我们的目的是研究在功能受损的老年人中，使用自我测量的家庭血压测量，是否血压升高与卒中之间的关联减弱或逆转。方法：我们随访了501名年龄在60岁以上（平均年龄68.6岁）、无卒中史的日本社区居民。采用Cox比例风险模型计算家庭血压和办公室血压升高1 sd的多变量校正风险比。通过自我报告的身体功能来评估功能状态。结果：在中位11.5年的随访期间，47名参与者观察到首次中风。在349名身体功能正常的参与者和152名身体功能受损的参与者中，较高的家庭收缩压（而不是办公室收缩压）与卒中风险增加显著相关[每14.4 mmhg升高的风险比（95%置信区间）分别为1.74（1.12-2.69）和1.77(1.06-2.94)]，与身体功能没有显著的相互作用（P= 0.56）。无论身体功能如何，较高的家庭舒张压（而不是办公室舒张压）也与卒中风险增加显著相关（P≤0.029）（相互作用的P均为0.05）。无论身体功能如何，家庭血压和办公室血压与全因死亡率均无显著相关性。结论：较高的家庭血压与卒中风险增加有关，即使在身体功能受损的人群中也是如此。即使在身体机能下降后，家庭血压测量对预防中风也是有用的。
Objective:Several observational studies have found modifying effects of functional status on the association between conventional office blood pressure (BP) and adverse outcomes. We aimed to examine whether the association between higher BP and stroke was attenuated or inverted among older adults with impaired function using self-measured home BP measurements.Methods:We followed 501 Japanese community-dwelling adults aged at least 60 years (mean age, 68.6 years) with no history of stroke. Multivariate-adjusted hazard ratios for 1-SD increase in home BP and office BP measurements were calculated by the Cox proportional hazards model. Functional status was assessed by self-reported physical function.Results:During a median follow-up of 11.5 years, first strokes were observed in 47 participants. Higher home SBP, but not office SBP, was significantly associated with increased risk of stroke among both 349 participants with normal physical function and 152 participants with impaired physical function [hazard ratio (95% confidence interval) per 14.4-mmHg increase: 1.74 (1.12–2.69) and 1.77 (1.06–2.94), respectively], with no significant interaction for physical function (P= 0.56). Higher home DBP, but not office DBP, was also significantly associated with increased risk of stroke (P≤ 0.029) irrespective of physical function (all P> 0.05 for interaction). Neither home BP nor office BP was significantly associated with all-cause mortality irrespective of physical function.Conclusion:Higher home BP was associated with increased risk of stroke even among those with impaired physical function. Measurements of home BP would be useful for stroke prevention, even after physical function decline.