Prognostic value of home blood pressure monitoring in patients under antihypertensive treatment.
Prognostic value of home blood pressure monitoring in patients under antihypertensive treatment.
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DOI：
10.1038/s41371-022-00758-x
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发表时间：
2023-09
影响因子：
2.7
通讯作者：
Boggia, Jose
中科院分区：
文献类型：
--
作者：
Barochiner, Jessica;Aparicio, Lucas S.;Martinez, Rocio;Boggia, Jose
家庭血压监测（HBPM）的预后价值已在几项针对普通人群的研究中进行了调查，证明其与心血管事件的独立关联。然而，在治疗高血压的病例中，证据是有争议的。我们的目的是评估HBPM在该人群中的预后价值。在2008年至2015年期间接受4天HBPM（欧姆龙®HEM-705CP-II）治疗的高血压患者的中位随访时间为5.9年，记录了致命和非致命心血管事件的复合主要结局。采用Cox回归模型分析HBPM的预后价值，考虑4天测量，丢弃第一天，分别分析上午、下午和晚上时段。我们纳入1582例患者进行分析（33.4%为男性，中位年龄70.8岁，平均使用2.1种降压药）。在随访期间，共发生273起事件。在未调整的模型中，HBPM在所有五种情况下都与心血管事件显著相关。当调整办公室血压和其他心血管危险因素时，在4天的时间内，这种关联仍然是边际显著的，丢弃第一天的HBPM测量（HR分别为1.04 [95% CI 1-1.1]和1.04 [95% CI 1-1.1]），并且在所有单独的测量期间具有统计学意义：HR 1.32 (95% CI 1.01-1.72)；1.33 (95% ci 1.02-1.72)；和1.30 (95% CI 1.01-1.67)，分别为上午、下午和晚上。当分别分析致死性和非致死性事件时，只有前者具有统计学意义。总之，HBPM是正在接受治疗的高血压患者心血管事件的独立预测因子。
The prognostic value of home blood pressure monitoring (HBPM) has been investigated in several studies in the general population, demonstrating its independent association with cardiovascular events. However, in the case of treated hypertensive subjects, evidence is controversial. Our purpose was to evaluate the prognostic value of HBPM in this population. Medicated hypertensive patients who performed a 4-day HBPM (Omron® HEM-705CP-II) between 2008 and 2015 were followed up for a median of 5.9 years, registering the occurrence of a composite primary outcome of fatal and non-fatal cardiovascular events. Cox regression models were used to analyze the prognostic value of HBPM, considering 4-day measurements, discarding the first day, and analyzing morning, afternoon and evening periods separately. We included 1582 patients in the analysis (33.4% men, median age 70.8 years, on an average of 2.1 antihypertensive drugs). During follow-up, 273 events occurred. HBPM was significantly associated with cardiovascular events in all five scenarios in the unadjusted models. When adjusting for office BP and other cardiovascular risk factors, the association remained marginally significant for the 4-day period, discarding first-day measurements HBPM (HR 1.04 [95% CI 1–1.1] and 1.04 [95% CI 1–1.1], respectively) and statistically significant for all separate periods of measurement: HR 1.32 (95% CI 1.01–1.72); 1.33 (95% CI 1.02–1.72); and 1.30 (95% CI 1.01–1.67), for morning, afternoon and evening, respectively. When analyzing separately fatal and non-fatal events, statistical significance was held for the former only. In conclusion, HBPM is an independent predictor of cardiovascular events in hypertensives under treatment.
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