近期，多国学者联合对老年人家庭血压的临界值进行了研究，结果表明，在未接受治疗的80至90岁人群中，家庭收缩压≥152.4 mmHg和舒张压≤65.1 mm Hg增其心血管风险，而家庭舒张压≥82 mm Hg则可使风险最小。在那些接受治疗的患者中，收缩压<126.9 mm Hg与总死亡增加有关，而达到148.6 mm Hg时风险最低。相关论文7月27日在线发表于《高血压》(HYPERTENSION)杂志。

        研究者们分析了375例80至90岁受试者(女性60.3%，平均年龄83.0岁)，对其中位随访5.5年。

        结果显示，共有155例受试者死亡，其中76例源于心血管疾病，而经历心血管、心脏、冠状动脉或脑血管事件的数量分别为104、 55、36和51例。

        在202例未接受治疗的受试者中，与多变量校正平均危险相比，家庭舒张压在最低五分位(≤65.1 mm Hg)的患者与心血管死亡和发病率风险增加有关[危险比(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险比为0.37 (P=0.034)。

        在173例接受高血压治疗的患者中，家庭收缩压在最低五分位(<126.9 mm Hg)的患者总死亡危险比为2.09 (P=0.020)。

        对家庭血压持续变量进一步分析显示，在未接受治疗的受试者中，舒张压较高预示着较低的心血管死亡率和发病率以及心脏和冠脉风险(HR≤0.65; P≤0.039)。而在接受治疗的患者中，心血管发病率与家庭收缩压呈曲线相关性，最低点在148.6 mm Hg处，在这个临界值以下，每降低1SD的HR值为1.45(P=0.046)。

        参考文献：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.