Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure

Kei Asayama, Takayoshi Ohkubo, Hirohito Metoki, Taku Obara, Ryusuke Inoue, Masahiro Kikuya, Lutgarde Thijs, Jan A. Staessen, Yutaka Imai

研究成果: Article査読

122 被引用数 (Scopus)

抄録

Hypertension guidelines recommend blood pressure self-measurement at home (HBP), but no previous trial has assessed cardiovascular outcomes in hypertensive patients treated according to HBP. The multicenter Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP; 2001-2010) trial involved 3518 patients (50% women; mean age 59.6 years) with an untreated systolic/diastolic HBP of 135-179/85-119 mm Hg. In a 2 × 3 design, patients were randomized to usual control (125-134/80-84 mm Hg (UC)) vs. tight control (<125/<80 mm Hg (TC)) of HBP and to initiation of drug treatment with angiotensin converting enzyme inhibitors, angiotensin receptor blockers or calcium channel blockers. During follow-up, a computer algorithm automatically generated treatment recommendations based on HBP. At the last follow-up (median 5.3 years), TC patients used more antihypertensive drugs than UC patients (1.82 vs. 1.74 defined daily doses, P0.045) and had a greater HBP reduction (21.3/13.1 mm Hg vs. 22.7/13.9 mm Hg, P0.018/0.020), but they less frequently achieved the lower HBP targets (37.4 vs. 63.5%, P<0.0001). The primary end point, cardiovascular death plus stroke and myocardial infarction, occurred in 25 UC and 26 TC patients (hazard ratio, 1.02; 95% confidence interval, 0.59-1.77; P0.94). Rates were similar (P0.13) in the three drug groups. In all patients combined, the risk of the primary end point independently increased by 41% (6-89%; P0.019) and 47% (15-87%; P0.0020) for a 1-s.d. increase in baseline (12.5 mm Hg) and follow-up (13.2 mm Hg) systolic HBP. The 5-year risk was minimal (≤1%) if on-treatment systolic HBP was 131.6 mm Hg or less. HOMED-BP proved the feasibility of adjusting antihypertensive drug treatment based on HBP and suggests that a systolic HBP level of 130 mm Hg should be an achievable and safe target.

本文言語English
ページ(範囲)1102-1110
ページ数9
ジャーナルHypertension Research
35
11
DOI
出版ステータスPublished - 2012 11

ASJC Scopus subject areas

  • 内科学
  • 生理学
  • 循環器および心血管医学

フィンガープリント

「Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure」の研究トピックを掘り下げます。これらがまとまってユニークなフィンガープリントを構成します。

引用スタイル