Portal de Periódicos da CAPES

Home blood-pressure control in Japanese hypertensive population

1997; Elsevier BV; Volume: 350; Issue: 9073 Linguagem: Inglês

10.1016/s0140-6736(05)62255-6

1474-547X

Kozo Matsubayashi, Kiyohito Okumiya, Tomoko Wada, Yoshinori Doi, Toshio Ozawa,

Dementia and Cognitive Impairment Research

Giuseppe Mancia and colleagues (Feb 15, p 454)1Mancia G Sega R Milesi C Cesana G Zanchetti A Blood-pressure control in the hypertensive population.Lancet. 1997; 349: 454-457Summary Full Text Full Text PDF PubMed Scopus (311) Google Scholar suggest that among the Italian hypertensive population, the number of patients with inadequate blood-pressure control is high not only when assessed in the clinic but also when assessed at home. We have investigated blood-pressure control at home among hypertensive patients living in Kahoku, a rural Japanese town.2Matsubayashi K Okumiya K Wada T Osaki Y Doi Y Ozawa T Secular improvement in self-care independence of old people living in Kahoku, Japan.Lancet. 1996; 347: 60Summary Full Text PDF PubMed Scopus (54) Google Scholar Our study comprised 2582 adults (1017 aged 25–64 years, 1565 aged ≥65 years), which was 52% of the eligible adult population of Kahoku. We defined home blood pressure as the mean value of 20 home measurements of blood pressure. The participants used a semi-automatic device to take readings twice daily, morning and evening, for 5 days. In the absence of firm criteria for what constitutes hypertension at home, we defined home hypertension as being greater than or equal to the mean of home blood pressure plus one SD of home blood pressure values (ie, 135/85 mm Hg) in 708 untreated hypertensive and normotensive participants aged 25–64 years (mean age 53·4 [SD 7·0] years) in the cohort. Because 135/85 mm Hg at home was in about the 79th percentile of the normal distribution, values of home blood pressure below 135/85 mm Hg were defined as definitely home normotensive. Participants who were receiving treatment for hypertension were defined as treated hypertensives. Individuals without any hypertensive medication were classified as untreated hypertensives or normotensives according to the above criteria. The table shows the mean values for home blood pressure in the normotensive, untreated hypertensive, and treated hypertensive participants aged 25–64 years and in those aged 65 years or older. In the population reported by Mancia and co-workers,1Mancia G Sega R Milesi C Cesana G Zanchetti A Blood-pressure control in the hypertensive population.Lancet. 1997; 349: 454-457Summary Full Text Full Text PDF PubMed Scopus (311) Google Scholar the mean clinic and home blood-pressure values of treated hypertensives were only slightly less or did not differ from those of the untreated hypertensives. By contrast, we found that both the home systolic and diastolic blood pressures of treated hypertensives were significantly higher than those of normotensives, but were significantly lower than those of untreated hypertensives aged 25–64 years. Although home blood-pressure values were higher among participants aged 65 or older than among those aged 25–64 years, there were significant differences in systolic and diastolic home blood-pressure values between the three groups, even among those aged 65 or older. Home blood-pressure control was satisfactory in 58% of hypertensives aged 25–64 years and in 34% of those aged 65 years or older. Mancia and colleagues found that clinic blood-pressure control was adequate in only 28% of non-elderly treated hypertensive patients. Thus, home blood-pressure control seems to be more satisfactory among the hypertensive population of Kahoku, Japan, than among hypertensives in Monza, Italy.TableMean home blood-pressure values for normotensive, untreated hypertensive, and treated hypertensive participantsNormotensiveUntreated HTTreated HTANOVAParticipants aged 25–64 years (n=1017)Number577127313M/F234/34371/56129/184Age (years)53·7 (7·1)55·4 (6·4)*p<0·05 versus untreated HT.56·8 (6·3)†p<0·05 versus normotensive.0·0001Systolic BP116·2 (9·6)143·1 (8·3)*p<0·05 versus untreated HT.†p<0·05 versus normotensive.131·2 (15·6)†p<0·05 versus normotensive.0·0001Diastolic BP72·4 (7·5)87·8 (8·2)*p<0·05 versus untreated HT.†p<0·05 versus normotensive.81·3 (10·5)†p<0·05 versus normotensive.0·0001Number with home BP 65 years (n=1565)Number481326758M/F220/261159/167300/458Age (years)73·4 (6·6)75·7 (7·7)*p<0·05 versus untreated HT.75·9 (7·1)†p<0·05 versus normotensive.0·0001Systolic BP121·3 (9·2)145·4 (11·5)*p<0·05 versus untreated HT.†p<0·05 versus normotensive.140·2 (16·5)†p<0·05 versus normotensive.0·0001Diastolic BP71·9 (6·6)83·9 (9·9)*p<0·05 versus untreated HT.†p<0·05 versus normotensive.80·0 (9·6)†p<0·05 versus normotensive.0·0001Number with home BP <135/85 mm Hg260 (34·3%)All values are mean (SD). BP=blood pressure; HT=hypertensive.* p<0·05 versus untreated HT.† p<0·05 versus normotensive. Open table in a new tab All values are mean (SD). BP=blood pressure; HT=hypertensive.