Key result
Morning home BP strongly predicts CAD and stroke without a J-curve, potentially outperforming clinic readings.
Why the study?
Does morning home blood pressure predict CAD and stroke events better than clinic blood pressure in treated hypertensive patients?
Cohort (n=21,591)
Does morning home blood pressure predict CAD and stroke events better than clinic blood pressure in treated hypertensive patients?
Morning home blood pressure is a strong predictor of future CAD and stroke events in treated hypertensive patients, potentially superior to clinic blood pressure for risk stratification.
May favor morning home BP for CV risk stratification; leaves open whether it outperforms clinic BP in guiding therapy or outcomes.
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).
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Kario et al. (2016) conducted a cohort in Hypertension (n=21,591). Morning home systolic blood pressure ≥155 mm Hg vs. Morning home systolic blood pressure <125 mm Hg was evaluated on Coronary artery disease events (HR 6.24, 95% CI 2.82-13.84). Morning home systolic blood pressure ≥155 mm Hg strongly predicted coronary artery disease events compared with <125 mm Hg (HR 6.24; 95% CI 2.82-13.84).
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