April 24, 2026Journal of the American College of Cardiology178 citationsOpen Access
View Full PaperMorning Home Blood Pressure Is a Strong Predictor of Coronary Artery Disease
Key Result
Morning home blood pressure strongly predicts future coronary artery disease and stroke events without a J-curve relationship, and may be superior to clinic blood pressure.
Key Points
- This research aims to evaluate morning home blood pressure as a predictor of coronary artery disease events.
- Utilized data from the HONEST study, involving 21,591 treated hypertensive patients with a follow-up of 2.02 years.
- Investigated associations between morning home blood pressure and the incidence of stroke and CAD events.
- Identified 121 CAD events per 1,000 patient-years, correlating higher morning systolic blood pressure with increased CAD risk.
- Morning home systolic blood pressure ≥155 mm Hg had a hazard ratio of 6.24 for CAD events, indicating strong predictive capability.
Structured PICO
Does morning home blood pressure predict future CAD and stroke events better than clinic blood pressure in olmesartan naive patients?
P
Population
Olmesartan naive patients
I
Intervention
Morning home blood pressure (HBP) measurement
C
Comparator
Clinic blood pressure measurement
O
Outcome
Future coronary artery disease (CAD) and stroke eventshard clinical
Morning home blood pressure is a strong predictor of future CAD and stroke events and may be superior to clinic blood pressure for risk stratification.
Main Result
Absolute Event Rate: 0% vs 0%
Abstract
BACKGROUND: Few studies have evaluated out-of-office blood pressure (BP) measurements as predictors of coronary artery disease (CAD) events. OBJECTIVES: The aim of this study was to determine morning home blood pressure (HBP) as a predictor of CAD events. METHODS: Using data from the HONEST (Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure) study, we investigated the relationship between morning HBP and incidence of stroke and CAD events. RESULTS: In 21,591 treated hypertensive patients (mean age 64.9 years; mean follow-up 2.02 years), 127 stroke events (2.92 per 1,000 patient-years), and 121 CAD events (2.78 per 1,000 patient-years) occurred. The incidence of stroke events was significantly higher in patients with morning home systolic blood pressure (HSBP) ≥145 mm Hg compared with <125 mm Hg, and in patients with clinic systolic blood pressure (CSBP) ≥150 mm Hg compared with <130 mm Hg. Hazard ratios (HRs) were 6.01 (95% confidence interval CI: 2.85 to 12.68) between patients with morning HSBP ≥155 mm Hg and those with morning HSBP <125 mm Hg and 5.82 (95% CI: 3.17 to 10.67) between patients with CSBP ≥160 mm Hg and those with CSBP <130 mm Hg; morning HSBP predicted stroke events similarly to CSBP. Incidence of CAD events was significantly higher in patients with morning HSBP ≥145 mm Hg compared with <125 mm Hg and in patients with CSBP ≥160 mm Hg compared with <130 mm Hg. The HR for morning HSBP ≥155 mm Hg was 6.24 (95% CI: 2.82 to 13.84) and for CSBP ≥160 mm Hg was 3.51 (95% CI: 1.71 to 7.20); therefore, compared with morning HSBP, CSBP may underestimate CAD risk. Goodness-of-fit analysis showed that morning HSBP predicted CAD events more strongly than CSBP. CONCLUSIONS: Morning HBP is a strong predictor of future CAD and stroke events, and may be superior to clinic BP in this regard. There does not appear to be a J-curve in the relationship between morning HBP and stroke or CAD events. (Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure Study HONEST; UMIN000002567).