自己測定された家庭血圧の季節変動の振幅と心血管転帰の関連：homed-BP（血圧の電気装置による測定に基づく高血圧客観的治療）研究

背景：自己測定された家庭血圧（BP）の長期的な季節変動の臨床的意義は、心血管疾患予防のために解明されていません。 METHODS AND RESULTS: Eligible 2787 patients were classified into 4 groups according to the magnitude of their seasonal variation in home BP, defined as an average of all increases in home BP from summer (July-August) to winter (January-February) combined with all decreases from winter to summer throughout the follow-up period, namely inverse- (systolic/diastolic, <0/<0 mm Hg), small-（0-4.8/0-2.4 mm Hg）、中間 - （4.8-9.1/2.4-4.5 mm Hg）、または大量（≥9.1/≥4.5mm Hg）変動グループ。全体的な心血管リスクは、グループ全体でU字型の関係を示し、小変数群と比較したすべての心血管転帰のハザード比は、逆変数群および大規模な分析群の3.07（p = 0.004）および2.02（p = 0.041）でした。さらに、季節に応じて降圧薬の滴定と先細りを経験した患者の間で夏の冬の家のBPの違いが評価された場合、差は（12月〜2月）滴定群（3.9/1.2 mm HG対7.3/3.1 MM HG）の場合（3.9/1.2 mm HG）、P <0.001）よりも（3.9/1.2 mm Hg）、P <0.001）よりも著しく小さくなりました。（6月〜8月）緊張群（4.4/2.1 mm Hg対7.1/3.4 mm Hg、P <0.001）。 結論：降圧薬の早期の調整に部分的に起因する可能性のあるホームBP（0-9.1/0-4.5 mm Hg）の中小季節変動は、より良い心血管の結果と関連していた。

BACKGROUND: The clinical significance of long-term seasonal variations in self-measured home blood pressure (BP) has not been elucidated for the cardiovascular disease prevention. METHODS AND RESULTS: Eligible 2787 patients were classified into 4 groups according to the magnitude of their seasonal variation in home BP, defined as an average of all increases in home BP from summer (July-August) to winter (January-February) combined with all decreases from winter to summer throughout the follow-up period, namely inverse- (systolic/diastolic, <0/<0 mm Hg), small- (0-4.8/0-2.4 mm Hg), middle- (4.8-9.1/2.4-4.5 mm Hg), or large- (≥9.1/≥4.5 mm Hg) variation groups. The overall cardiovascular risks illustrated U-shaped relationships across the groups, and hazard ratios for all cardiovascular outcomes compared with the small-variation group were 3.07 (P=0.004) and 2.02 (P=0.041) in the inverse-variation group and large-variation group, respectively, based on systolic BP, and results were confirmatory for major adverse cardiovascular events. Furthermore, when the summer-winter home BP difference was evaluated among patients who experienced titration and tapering of antihypertensive drugs depending on the season, the difference was significantly smaller in the early (September-November) than in the late (December-February) titration group (3.9/1.2 mm Hg versus 7.3/3.1 mm Hg, P<0.001) as well as in the early (March-May) than in the late (June-August) tapering group (4.4/2.1 mm Hg versus 7.1/3.4 mm Hg, P<0.001). CONCLUSIONS: The small-to-middle seasonal variation in home BP (0-9.1/0-4.5 mm Hg), which may be partially attributed to earlier adjustment of antihypertensive medication, were associated with better cardiovascular outcomes.