近期，多國學者聯合對老年人家庭血壓的臨界值進行了研究，結果表明，在未接受治療的80至90歲人群中，家庭收縮壓≥152.4 mmHg和舒張壓≤65.1 mm Hg增其心血管風險，而家庭舒張壓≥82 mm Hg則可使風險最小。在那些接受治療的患者中，收縮壓<126.9 mm Hg與總死亡增加有關，而達到148.6 mm Hg時風險最低。相關論文7月27日在線發表於《高血壓》(HYPERTENSION)雜誌。

        研究者們分析了375例80至90歲受試者(女性60.3%，平均年齡83.0歲)，對其中位隨訪5.5年。

        結果顯示，共有155例受試者死亡，其中76例源於心血管疾病，而經曆心血管、心髒、冠狀動脈或腦血管事件的數量分別為104、 55、36和51例。

        在202例未接受治療的受試者中，與多變量校正平均危險相比，家庭舒張壓在最低五分位(≤65.1 mm Hg)的患者與心血管死亡和發病率風險增加有關[危險比(HR)≥1.96; P≤0.022]，而最高五分位(≥82.0 mm Hg)患者的心血管死亡危險比為0.37 (P=0.034)。

        在173例接受高血壓治療的患者中，家庭收縮壓在最低五分位(<126.9 mm Hg)的患者總死亡危險比為2.09 (P=0.020)。

        對家庭血壓持續變量進一步分析顯示，在未接受治療的受試者中，舒張壓較高預示著較低的心血管死亡率和發病率以及心髒和冠脈風險(HR≤0.65; P≤0.039)。而在接受治療的患者中，心血管發病率與家庭收縮壓呈曲線相關性，最低點在148.6 mm Hg處，在這個臨界值以下，每降低1SD的HR值為1.45(P=0.046)。

        參考文獻：Lucas S. Aparicio, et al. HYPERTENSIONAHA.115.05800Published online before print July 27, 2015,doi: 10.1161/HYPERTENSIONAHA.115.05800

Defining Thresholds for Home Blood Pressure Monitoring in Octogenarians
1. Lucas S. Aparicio,
2. Lutgarde Thijs,
3. José Boggia,
4. Lotte Jacobs,
5. Jessica Barochiner,
6. Augustine N. Odili,
7. José Alfie,
8. Kei Asayama,
9. Paula E. Cuffaro,
10. Kyoko Nomura,
11. Takayoshi Ohkubo,
12. Ichiro Tsuji,
13. George S. Stergiou,
14. Masahiro Kikuya,
15. Yutaka Imai,
16. Gabriel D. Waisman,
17. Jan A. Staessen,
18. on behalf of the International Database on Home Blood Pressure in Relation to Cardiovascular Outcome (IDHOCO) Investigators
-Author Affiliations
1. From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
1. Correspondence to Jan A. Staessen, Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Campus SintRafaël, Kapucijnenvoer 35, PO Box 7001, BE-3000 Leuven, Belgium. E-mail jan.staessen@med.kuleuven.be
Abstract
To generate outcome-driven thresholds for home blood pressure (BP) in the elderly, we analyzed 375 octogenarians (60.3% women; 83.0 years [mean]) enrolled in the International Database on home BP in relation to cardiovascular outcome. Over 5.5 years (median), 155 participants died, 76 from cardiovascular causes, whereas 104, 55, 36, and 51 experienced a cardiovascular, cardiac, coronary, or cerebrovascular event, respectively. In 202 untreated participants, home diastolic in the lowest fifth of the distribution (≤65.1 mm Hg) compared with the multivariable-adjusted average risk was associated with increased risk of cardiovascular mortality and morbidity (hazard ratios [HRs], ≥1.96; P≤0.022), whereas the HR for cardiovascular mortality in the top fifth (≥82.0 mm Hg) was 0.37 (P=0.034).
Among 173 participants treated for hypertension, the HR for total mortality in the lowest fifth of systolic home BP (<126.9 mm Hg) was 2.09 (P=0.020). In further analyses of home BP as continuous variable (per 1-SD increment), higher diastolic BP predicted lower cardiovascular mortality and morbidity and cardiac and coronary risk (HR≤0.65; P≤0.039) in untreated participants. In those treated, cardiovascular morbidity was curvilinearly associated with systolic home BP with nadir at 148.6 mm Hg and with a 1.45 HR (P=0.046) for a 1-SD decrease below this threshold.
In conclusion, in untreated octogenarians, systolic home BP ≥152.4 and diastolic BP ≤65.1 mm Hg entails increased cardiovascular risk, whereas diastolic home BP ≥82 mm Hg minimizes risk. In those treated, systolic home BP <126.9 mm Hg was associated with increased total mortality with lowest risk at 148.6 mm Hg.