Epidemiologic study on the prognostic value of ambulatory and home blood pressure measurements

自1987年以来，我们一直在日本岩手县大阪测量4500名居民的家庭血压(HBP)、24小时动态血压(ABP)和临时血压(CBP)，并对他们的健康相关结果进行跟踪调查。根据血压与死亡率的关系，提出高血压的参考值为137/84 mm Hg，正常血压参考值为收缩压在137 mm Hg以下，舒张压在66~83 mm Hg之间，舒张压在66 mm Hg以下为低舒张压。为此，我们对随机抽样的151名65岁及以上的人进行了脑部磁共振成像(MRI)测试。结果表明，有1个或2个腔隙性脑梗死组的老年女性夜间血压下降幅度或下降率明显高于无腔隙性脑梗死组。老年女性夜间血压下降幅度或下降率与脑室周围高强度程度呈显著正相关。这种关系在中年晚期的女性中观察到，但在男性中没有观察到；这种关系在老年男性中没有看到。这类妇女的高血压治疗应注意并考虑到夜间血压。

We have been measuring home blood pressure (HBP), 24-hr ambulatory blood pressure (ABP), and casual blood pressure (CBP) on 4500 residents at Ohasama, Iwate Prefecture, Japan since 1987, and following up their health-related outcome.We compared predictive power for mortality among the above three methods for blood pressure (BP) measurement. The results indicated that predictive power of both HBP and ABP levels for mortality was stronger than that of casual screening BP.Based on this relation between HBP values and mortality, we propose that the reference value for hypertension is 137/84 mmHg, and normotension is below 137 mmHg for home systolic BP and between 66 and 83 mmHg for home diastolic BP.Home diastolic BP below 66 mmHg should be considered as low diastolic blood pressure.We investigated the effect of nocturnal decline of BP upon development of silent cerebral infarction. For this purpose, we performed magnetic resonance imaging (MRI) test of the brains on randomly sampled 151 individuals aged 65 years and over. The results indicated that the amplitude or the rate of the fall in nocturnal blood pressure in elderly women with one or two lacunar infarctions was significantly higher than that in those without such infarctions. There was a significant positive correlation between the amplitude or the rate of the fall in nocturnal blood pressure and the extent of periventricular hyperintensity in the elderly women. This relationship was observed in women, but not in men, of late middle age ; this was not seen in elderly men. Treatment of hypertension in such women should be administered with care and with regard to nocturnal blood pressure.