Office, Home, and Ambulatory Blood Pressures as Predictors of Cardiovascular Risk

Abstract

Abstract-Ambulatory blood pressure (BP) is considered as the gold standard of BP measurement although it has not been shown to be more strongly associated with cardiovascular risk than is home BP. Our objective was to compare the prognostic value of office, home, and ambulatory BP for cardiovascular risk in 502 participants examined in 1992 to 1996. The end point was a composite of cardiovascular mortality, myocardial infarction, stroke, heart failure hospitalization, and coronary intervention. We assessed the prognostic value of each BP in multivariable-adjusted Cox models. The likelihood χ 2 ratio value was used to test whether the addition of a BP variable improved the model's goodness of fit. After a follow-up of 16.1±3.9 years, 70 participants (13.9%) had experienced ≥1 cardiovascular event. Office (systolic/diastolic hazard ratio per 1/1 mm Hg increase in BP, 1.024/1.018; systolic/diastolic 95% confidence interval, 1.009-1.040/0.994-1.043), home (hazard ratio, 1.029/1.028; 95% confidence interval, 1.013-1.045/1.005-1.052), and 24-hour ambulatory BP (hazard ratio, 1.033/1.049; 95% confidence interval, 1.019-1.047/1.023-1.077) were predictive of cardiovascular events. When all 3 BP variables were included in the model simultaneously, only systolic/diastolic ambulatory BP was a significant predictor of cardiovascular events (P=0.002/<0.001

Morning and Evening Home Blood Pressure and Risks of Incident Stroke and Coronary Artery Disease in the Japanese General Practice Population

“…At least 7 cohorts (5 general populations and 2 general practice populations) [4][5][6][7][8][9][10] have assessed longitudinal associations between home BP measures and incident CVD events (Table S1). They found that combined morning and evening SBP is associated with CVD events, independently of office SBP.…”

“…They found that combined morning and evening SBP is associated with CVD events, independently of office SBP. [4][5][6][7][8] Only COX analyses were conducted in these studies, [4][5][6][7][8][9][10] and thus the clinical utility of home BP measurement has remained uncertain. 23 This limitation was resolved in the present study, which evaluated the discrimination and recalibration of risk prediction models.…”

“…This protocol provided several advantages over the prior home BP studies (Table S1 in the online-only Data Supplement). [4][5][6][7][8][9][10] First, the office and home BP were measured using the same validated, automatic, and oscillometric device (HEM-5001; Omron Healthcare Co., Ltd.) 19 In addition, to avoid reporting bias, BP data were automatically stored in the memory of the BP device and were downloaded to a computer by a physician or nurse during clinic visits. And finally, the present study had more BP readings than the previous home BP studies.…”

“…And finally, the present study had more BP readings than the previous home BP studies. [4][5][6][7][8][9][10] Laboratory methods are presented in the online-only Data Supplement. In 4264 of the total 4310 subjects, the spot urine albumin:creatinine ratio and plasma brain natriuretic peptide levels were also assessed at baseline.…”

Small Vessel Disease of the Brain and Stroke: Association with Clinic and Ambulatory Blood Pressure

“…The 24 hours ambulatory systolic and diastolic BPs were also found to be independent predictors of CV events, including stroke, in another observational study of 502 patients in Finland with 16.1 years of follow up. 27 Several other ambulatory blood pressure parameters have been studied for prediction of cardiovascular events. In a meta-analysis of 13,844 patients with hypertension 28 comprising nine cohorts from Europe, Japan, and Brazil, nocturnal (nighttime) systolic BP independently predicted higher CV risk.…”