Does Antihypertensive Drug Class Affect Day-to-Day Variability of Self-Measured Home Blood Pressure? The HOMED-BP Study.
Does Antihypertensive Drug Class Affect Day-to-Day Variability of Self-Measured Home Blood Pressure? The HOMED-BP Study.
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DOI：
10.1161/jaha.115.002995
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发表时间：
2016-03-23
影响因子：
5.4
通讯作者：
Hypertensive Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED‐BP) Study Investigators
中科院分区：
文献类型：
--
作者：
Asayama K;Ohkubo T;Hanazawa T;Watabe D;Hosaka M;Satoh M;Yasui D;Staessen JA;Imai Y;Hypertensive Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED‐BP) Study Investigators
最近的文献表明，血压变异性(BPV)可以预测超出血压水平(BPL)的预后，并且降压药物类别对BPV有不同的影响。我们比较了钙通道阻滞剂、血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂对新治疗高血压患者自测BPL和BPV的影响以及它们的预后意义。我们招募了2484名患者，随机分配到一线治疗，使用钙通道阻滞剂(n=833)、血管紧张素转换酶抑制剂(n=821)或血管紧张素受体阻滞剂(n=830)。在随机药物治疗前和治疗2-4周后，分别在停药前5天和治疗后5天测量家庭早晚血压。我们评估了BPL和BPV的变化，通过与平均值无关的变异性来估计，并比较了心血管结果。与钙通道阻滞剂和血管紧张素受体阻滞剂治疗组(收缩/舒张期：8.2/4.5 mm·Hg)相比，各组的Home Bpl反应均显著(P≤0.0001)，但血管紧张素转换酶抑制剂组(收缩/舒张期：4.60/2.8mmMm·Hg)与钙通道阻滞剂组(收缩/舒张期：8.3m/3.9mm.Hg.在多变量校正分析中，与平均值无关的家庭变异性的变化在3种药物类别之间没有差异(P≥0.054)。与治疗前平均值无关的夜间变异性显著预测硬心血管事件，独立于相应的家庭Bpl(P≤0.022)，而bpv不能基于早晨的测量预测任何心血管结果(P≥0.056)。单一治疗后捕获的家庭BPV对心血管结局没有预测能力(P≥0.22)。通过与平均值无关的变异性估计的自我测量的家庭夜间BPV具有预后意义，而降压药物类别对BPV的变化没有显著影响。家庭BPL应该仍然是风险分层和治疗的主要焦点。网址：http://www.umin.ac.jp/ctr/index.htm.唯一标识：C000000137。
Recent literature suggests that blood pressure variability (BPV) predicts outcome beyond blood pressure level (BPL) and that antihypertensive drug classes differentially influence BPV. We compared calcium channel blockers, angiotensin‐converting enzyme inhibitors, and angiotensin receptor blockade for effects on changes in self‐measured home BPL and BPV and for their prognostic significance in newly treated hypertensive patients. We enrolled 2484 patients randomly allocated to first‐line treatment with a calcium channel blocker (n=833), an angiotensin‐converting enzyme inhibitor (n=821), or angiotensin receptor blockade (n=830). Home blood pressures in the morning and evening were measured for 5 days off treatment before randomization and for 5 days after 2 to 4 weeks of randomized drug treatment. We assessed BPL and BPV changes as estimated by variability independent of the mean and compared cardiovascular outcomes. Home BPL response in each group was significant (P≤0.0001) but small in the angiotensin‐converting enzyme inhibitor group (systolic/diastolic: 4.6/2.8 mm Hg) compared with the groups treated with a calcium channel blocker (systolic/diastolic: 8.3/3.9 mm Hg) and angiotensin receptor blockade (systolic/diastolic: 8.2/4.5 mm Hg). In multivariable adjusted analyses, changes in home variability independent of the mean did not differ among the 3 drug classes (P≥0.054). Evening variability independent of the mean before treatment significantly predicted hard cardiovascular events independent of the corresponding home BPL (P≤0.022), whereas BPV did not predict any cardiovascular outcome based on the morning measurement (P≥0.056). Home BPV captured after monotherapy had no predictive power for cardiovascular outcome (P≥0.22). Self‐measured home evening BPV estimated by variability independent of the mean had prognostic significance, whereas antihypertensive drug classes had no significant impact on BPV changes. Home BPL should remain the primary focus for risk stratification and treatment. URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: C000000137.