Stroke risk in Systolic and combined Systolic and Diastolic hypertension determined using ambulatory blood pressure

被引:19
作者
Inoue, Ryusuke
Ohkubo, Takayoshi
Kikuya, Masahiro
Metoki, Hirohito
Asayama, Kei
Obara, Taku
Hirose, Takuo
Hara, Azusa
Hoshi, Haruhisa
Hashimoto, Junichiro
Totsune, Kazuhito
Satoh, Hiroshi
Kondo, Yoshiaki
Imai, Yutaka
机构
[1] Tohoku Univ, Grad Sch Pharmaceut Sci, Dept Clin Pharmacol & Therapeut, Aoba Ku, Sendai, Miyagi 9808574, Japan
[2] Tohoku Univ, Century COE Program Comprehens Res 21, Sendai, Miyagi 980, Japan
[3] Tohoku Univ, Educ Ctr Planning Drug Dev & Clin Evaluat, Sendai, Miyagi 980, Japan
[4] Tohoku Univ, Comprehens Res & Educ Ctr Planning Drug Dev & Cli, Sendai, Miyagi 980, Japan
[5] Tohoku Univ, Grad Sch Pharmaceut Sci & Med, Dept Clin Pharmacol & Therapeut, Sendai, Miyagi 980, Japan
[6] Ohasama Hosp, Dept Internal Med, Iwate, Japan
基金
日本学术振兴会;
关键词
systolic hypertension; ambulatory blood pressure; stroke;
D O I
10.1016/j.amjhyper.2007.04.017
中图分类号
R6 [外科学];
学科分类号
1002 [临床医学]; 100210 [外科学];
摘要
Background: To investigate the risk of stroke in subjects with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and combined systolic and diastolic hypertension (SDH) in a Japanese general population, we used 24-h ambulatory blood pressure (ABP) and casual-screening blood-pressure (CBP) readings. Methods: Subtypes of hypertension were defined based on systolic blood pressure (SBP) >135 mm Hg or diastolic blood pressure (DBP) >80 mm Hg for 24-h ABP, and SBP > 140 mm Hg or DBP >90 mm Hg for Cl3P. We obtained 24-h ABP and CBP data for 1271 (40% male) subjects aged >= 40 years (mean age, 61 years) without a history of symptomatic stroke; their stroke-free survival was then determined. The prognostic significance of each subtype of hypertension was determined by Cox proportional hazard analysis. Results: There were 113 symptomatic strokes during follow-up (mean time, 11 years). Compared with normo-tension, among the hypertension subtypes determined by 24-h ABP, the adjusted relative hazards (RHs) of stroke were 2.24 for ISH (P = .002) and 2.39 for SDH (P = .0004). The association was less marked among subtypes determined by CBP (RH = 1.40 and P = .13 for ISH; RH = 2.07 and P = .017 for SDH). The IDH group was excluded from the Cox analysis because both the prevalence and the number of events were low in this group. Conclusions: Isolated systolic hypertension, as determin ed by 24-h ABP measurements, was associated with a high risk of stroke, similar to that found in SDH subjects; this suggests that the prognosis of hypertensive patients would be improved by focusing treatment on 24-h systolic ABP.
引用
收藏
页码:1125 / 1131
页数:7
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