Characteristics of resistant hypertension determined by self-measured blood pressure at home and office blood pressure measurements: the J-HOME study
Characteristics of resistant hypertension determined by self-measured blood pressure at home and office blood pressure measurements: the J-HOME study
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DOI：
10.1097/01.hjh.0000242397.53214.27
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发表时间：
2006-09-01
影响因子：
4.9
通讯作者：
Imai, Yutaka
中科院分区：
文献类型：
--
作者：
Oikawa, Takuya;Obara, Taku;Imai, Yutaka
目的利用家庭和办公室自测血压诊断顽固性高血压，评价顽固性高血压患者的特点。方法528例高血压患者服用至少3种或3种以上不同的降压药。以家庭血压(135/85 mm Hg)和办公室血压(140/90 mm Hg)为界值，将受试者分为4组(控制性高血压、单纯办公室阻力高血压、单纯家庭阻力高血压和持续性阻力高血压)。结果528例患者中，控制性高血压占17.8%，单纯办公室阻力高血压占16.1%，单纯家庭阻力高血压占23.5%，持续性阻力高血压占42.6%。高胆固醇血症的存在被发现与孤立的办公室抵抗型高血压有显著和独立的关联。研究发现，较高的办公室收缩压(SBP)、既往的缺血性心脏病病史和较低的省钾利尿剂处方率与孤立性家族性高血压有显著且独立的关联。持续性难治性高血压患者的节钾利尿剂处方率明显低于控制性高血压患者。结论本研究证实了难治性高血压至少部分受白大衣效应的影响。在诊断和治疗难治性高血压时，应考虑家庭血压测量和其他与顽固性高血压相关的因素，如相对较高的办公室SBP、药物种类和心血管并发症。
Objectives To diagnose resistant hypertension using self-measured blood pressure (BP) at home and office BP, and to evaluate the characteristics of resistant hypertensive patients.Methods The subjects were 528 hypertensive patients taking at least three or more different antihypertensive drugs. Subjects were classified into four groups (controlled hypertension, isolated office resistant hypertension, isolated home resistant hypertension and sustained resistant hypertension) on the basis of the cut-off values of home BP (135/85 mmHg) and office BP (140/90 mmHg). The relationship between each resistant hypertension group and various factors was analysed using univariate and multivariate analyses.Results Of the 528 patients, 17.8% were classified with controlled hypertension, 16.1% with isolated office resistant hypertension, 23.5% with isolated home resistant hypertension and 42.6% with sustained resistant hypertension. The presence of hypercholesterolemia was found to have a significant and independent association with isolated office resistant hypertension. Higher office systolic blood pressure (SBP), a past history of ischaemic heart disease, and a lower prescription rate of potassium-sparing diuretics were found to have a significant and independent association with isolated home resistant hypertension. Patients with sustained resistant hypertension had a significantly lower prescription rate of potassium-sparing diuretics than those with controlled hypertension.Conclusions The present study demonstrated that resistant hypertension is mediated at least partly by the white-coat effect. Home BP measurements and other relevant factors associated with resistant hypertension, such as relatively higher office SBP, type of drugs prescribed, and cardiovascular complications, should be taken into account for the diagnosis and treatment of resistant hypertension.