Outcome-driven thresholds for home blood pressure measurement: international database of home blood pressure in relation to cardiovascular outcome.
Outcome-driven thresholds for home blood pressure measurement: international database of home blood pressure in relation to cardiovascular outcome.
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DOI：
10.1161/hypertensionaha.111.00100
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发表时间：
2013-01
期刊：
影响因子：
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通讯作者：
International Database of Home blood pressure in relation to Cardiovascular Outcome Investigators
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文献类型：
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作者：
Niiranen TJ;Asayama K;Thijs L;Johansson JK;Ohkubo T;Kikuya M;Boggia J;Hozawa A;Sandoya E;Stergiou GS;Tsuji I;Jula AM;Imai Y;Staessen JA;International Database of Home blood pressure in relation to Cardiovascular Outcome Investigators
缺乏结果驱动的操作阈值限制了家庭血压(BP)测量的临床应用。我们的目标是为家庭血压测量确定一个结果驱动的参照系。我们测量了6470名参与者的家庭和诊所血压(平均年龄59.3岁；56.9%的女性；22.4%接受抗高血压治疗)，这些参与者分别在日本大阪(n=2520)、乌拉圭蒙得维的亚(n=399)、日本Tsurugaya(n=811)、希腊迪迪玛(n=665)和芬兰全国(n=2075)招募。在对个体受试者数据的多变量调整分析中，我们确定了家庭血压阈值，其10年的心血管风险与临床测量的1期(120/80 mm Hg)和2期(130/85 mm Hg)高血压前期以及1期(140/90 mm Hg)和2期(160/100 mm Hg)高血压的风险相似。在8.3年的随访(中位数)中，整个队列中发生了716个心血管终点、294个心血管死亡、393个中风和336个心脏事件；在未经治疗的参与者中，这些数字分别为414、158、225和194。在整个队列中，与1和2期高血压前期和1期和2期高血压相对应的家庭血压结果驱动的收缩/舒张期阈值分别为121.4/77.7、127.4/79.9、133.4/82.2和145.4/86.8 mm Hg；在5018名未经治疗的参与者中，这些阈值分别为118.5/76.9、125.2/79.7、131.9/82.4和145.3/87.9 mm Hg。1和2期高血压前期和1期和2期高血压的四舍五入阈值分别为120/75、125/80、130/85和145/90 mm Hg。以人群为基础的结果驱动的家庭血压阈值略低于目前高血压指南中提出的阈值。我们目前的发现可以为指南提供参考，并帮助临床医生诊断和管理患者。
The lack of outcome-driven operational thresholds limits the clinical application of home blood pressure (BP) measurement. Our objective was to determine an outcome-driven reference frame for home BP measurement. We measured home and clinic BP in 6470 participants (mean age, 59.3 years; 56.9% women; 22.4% on antihypertensive treatment) recruited in Ohasama, Japan (n=2520); Montevideo, Uruguay (n=399); Tsurugaya, Japan (n=811); Didima, Greece (n=665); and nationwide in Finland (n=2075). In multivariable-adjusted analyses of individual subject data, we determined home BP thresholds, which yielded 10-year cardiovascular risks similar to those associated with stages 1 (120/80 mm Hg) and 2 (130/85 mm Hg) prehypertension, and stages 1 (140/90 mm Hg) and 2 (160/100 mm Hg) hypertension on clinic measurement. During 8.3 years of follow-up (median), 716 cardiovascular end points, 294 cardiovascular deaths, 393 strokes, and 336 cardiac events occurred in the whole cohort; in untreated participants these numbers were 414, 158, 225, and 194, respectively. In the whole cohort, outcome-driven systolic/diastolic thresholds for the home BP corresponding with stages 1 and 2 prehypertension and stages 1 and 2 hypertension were 121.4/77.7, 127.4/79.9, 133.4/82.2, and 145.4/86.8 mm Hg; in 5018 untreated participants, these thresholds were 118.5/76.9, 125.2/79.7, 131.9/82.4, and 145.3/87.9 mm Hg, respectively. Rounded thresholds for stages 1 and 2 prehypertension and stages 1 and 2 hypertension amounted to 120/75, 125/80, 130/85, and 145/90 mm Hg, respectively. Population-based outcome-driven thresholds for home BP are slightly lower than those currently proposed in hypertension guidelines. Our current findings could inform guidelines and help clinicians in diagnosing and managing patients.