Maximum Value of Home Blood Pressure

Abstract

Abstract-The maximum office systolic blood pressure (SBP) has been shown to be a strong predictor of cardiovascular events, independently of the mean SBP level. However, the clinical implications of maximum home SBP have never been reported. We investigated the association between the maximum home SBP and target organ damage (TOD). We assessed the left ventricular mass index (LVMI) and carotid intima-media thickness (IMT) using ultrasonography and the urinary albumin/creatinine ratio (UACR) as measures of TOD in 356 never-treated hypertensive subjects. Home BP was taken in triplicate in the morning and evening, respectively, for 14 consecutive days with a memory-equipped device. The maximum home SBP was defined as the maximum mean triplicate BP reading in the 14-day period for each individual and was significantly correlated with LVMI (rϭ0.51, PϽ0.001), carotid IMT (rϭ0.40, PϽ0.001), and UACR (rϭ0.29, PϽ0.001). The correlation coefficients with LVMI and carotid IMT were significantly larger for the maximum home SBP than the mean home SBP. In multivariate regression analyses, the maximum home SBP was independently associated with LVMI and carotid IMT, regardless of the mean home BP level. In the prediction of left ventricular hypertrophy and carotid atherosclerosis, the goodness-of-fit of the model was significantly improved when the maximum home SBP was added to the sum of the mean office and home BPs (Pϭ0.002 and PϽ0.001, respectively). These findings indicate that assessment of the maximum home SBP, in addition to the mean home SBP, might increase the predictive value of hypertensive TOD in the heart and artery. Key Words: maximum home systolic blood pressure Ⅲ mean home systolic blood pressure Ⅲ left ventricular mass index Ⅲ carotid intima-media thickness Ⅲ urinary albumin/creatinine ratio Ⅲ aging Ⅲ arterial stiffness I t has been believed that transient increases in blood pressure (BP) might be construed as noise and merely an obstacle to reliable estimation of usual BP (conceived as the true underlying average BP over a period of time). In this case, such increases would result in substantial underestimation of the strength of the real association between usual BP and cardiovascular risk, a so-called "regression dilution bias." 1 Rothwell et al 2 recently showed that the maximum systolic BP (SBP) reached in an office setting was a strong predictor of cardiovascular events, independently of the mean SBP over 12 to 36 months. Ko et al 3 also showed that the maximum SBP during the first 72 hours of acute ischemic stroke was strongly associated with the development of brain hemorrhagic transformation, independently of the mean SBP level. Thus, subjects with episodic high BP might be at a high cardiovascular risk.One drawback of the use of the maximum SBP in routine clinical management of hypertension is that obtaining it requires several office visits over a period of time. One possible way to solve this is to observe the maximum SBP derived from self-measurement at home, because this selfmeasurement makes it p...

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