Key result
Higher 24-hour systolic blood pressure was associated with an increased risk of incident home hypertension (HR 1.59 per 1-SD increase; 95% CI 1.33 to 1.90).
Why the study?
To investigate the association between ambulatory blood pressure and the risk of home hypertension in normotensive individuals, and whether adding ambulatory BP improves 10-year risk prediction.
Does ambulatory blood pressure predict the risk of home hypertension in a normotensive population?
Cohort (n=410)
No
Does ambulatory blood pressure predict the risk of home hypertension in a normotensive population?
Hazard Ratio: 1.59 (95% CI 1.33–1.9)
24-hour systolic blood pressure is an independent predictor of future home hypertension in normotensive individuals, improving risk prediction models.
24-h SBP was associated with incident home hypertension; extends risk models yet leaves practice implications open pending trials.
BACKGROUND: We investigated the association between ambulatory blood pressure (BP) and the risk of home hypertension in a normotensive population and whether considering ambulatory BP improves the 10-year prediction model for home hypertension risk, which was developed in the previous Ohasama Study. METHODS: In this prospective study, we followed up with 410 participants (83.2% women; age, 53.6 years) without a home and ambulatory hypertension in the general population of Ohasama, Japan. The Cox model was used to assess the hazard ratios (HRs) for home hypertension (home BP ≥ 135/≥85 mmHg or the initiation of antihypertensive treatment) and model improvement. RESULTS: During a mean 14.2-year follow-up, 225 home hypertension incidences occurred. The HR (95% confidence interval) for home hypertension incidence per 1-SD higher (=6.76 mmHg) 24-hour systolic BP (SBP) was 1.59 (1.33 to 1.90), after adjustments for possible confounding factors, including baseline home SBP. Harrell's C-statistics increased from 0.72 to 0.73 (P = 0.11) when 24-hour SBP was added to the basic 10-year home hypertension prediction model, which includes sex, age, body mass index, smoking status, office SBP, and baseline home SBP. Continuous net reclassification improvement (0.53, P < 0.0001) and integrated discrimination improvement (0.028, P = 0.0014) revealed improvement in the model. CONCLUSIONS: A total of 24-hour SBP could be an independent predictor of future home hypertension. Home BP and 24-hour BP can longitudinally influence each other in the long term.
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Nakayama et al. (2022) conducted a cohort in Normotension (n=410). 24-hour systolic blood pressure vs. Lower 24-hour systolic blood pressure was evaluated on Home hypertension (home BP ≥ 135/≥85 mmHg or the initiation of antihypertensive treatment) (HR 1.59, 95% CI 1.33 to 1.90). Higher 24-hour systolic blood pressure was associated with an increased risk of incident home hypertension (HR 1.59 per 1-SD increase; 95% CI 1.33 to 1.90).
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