Morning and Evening Home Blood Pressure and Risks of Incident Stroke and Coronary Artery Disease in the Japanese General Practice Population
Autor: | Akira Nakamura, Kayo Yamagiwa, Satoshi Hoshide, Kiyoshi Uchiba, Kazuomi Kario, Yuichiro Yano, Kazuo Eguchi, Shoichiro Nagasaka, Hajime Haimoto, Yoshio Matsui, Motoki Fukutomi, Joji Ishikawa |
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Rok vydání: | 2016 |
Předmět: |
Male
medicine.medical_specialty Evening Databases Factual General Practice Population Coronary Artery Disease 030204 cardiovascular system & hematology Severity of Illness Index Cohort Studies Coronary artery disease 03 medical and health sciences Age Distribution 0302 clinical medicine Japan Risk Factors Internal medicine Confidence Intervals Internal Medicine medicine Humans 030212 general & internal medicine Sex Distribution Intensive care medicine education Stroke Antihypertensive Agents Aged Proportional Hazards Models Retrospective Studies Morning education.field_of_study business.industry Blood Pressure Determination Blood Pressure Monitoring Ambulatory Middle Aged medicine.disease Confidence interval Circadian Rhythm Survival Rate Blood pressure Hypertension Cardiology Female business Cohort study |
Zdroj: | Hypertension. 68:54-61 |
ISSN: | 1524-4563 0194-911X |
Popis: | Our aim is to determine the optimal time schedule for home blood pressure (BP) monitoring that best predicts stroke and coronary artery disease in general practice. The Japan Morning Surge-Home Blood Pressure (J-HOP) study is a nationwide practice-based study that included 4310 Japanese with a history of or risk factors for cardiovascular disease, or both (mean age, 65 years; 79% used antihypertensive medication). Home BP measures were taken twice daily (morning and evening) over 14 days at baseline. During a mean follow-up of 4 years (16 929 person-years), 74 stroke and 77 coronary artery disease events occurred. Morning systolic BP (SBP) improved the discrimination of incident stroke ( C statistics, 0.802; 95% confidence interval, 0.692–0.911) beyond traditional risk factors including office SBP (0.756; 0.646–0.866), whereas the changes were smaller with evening SBP (0.764; 0.653–0.874). The addition of evening SBP to the model (including traditional risk factors plus morning SBP) significantly reduced the discrimination of incident stroke ( C statistics difference, −0.008; 95% confidence interval: −0.015 to −0.008; P =0.03). The category-free net reclassification improvement (0.3606; 95% confidence interval, 0.1317–0.5896), absolute integrated discrimination improvement (0.015; SE, 0.005), and relative integrated discrimination improvement (58.3%; all P Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr/ . Unique identifier: UMIN000000894. |
Databáze: | OpenAIRE |
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