Overall cardiovascular prognosis of isolated systolic hypertension, isolated diastolic hypertension and pulse pressure defined with home measurements

OBJECTIVE: The overall cardiovascular prognosis of isolated systolic hypertension, isolated diastolic hypertension and pulse pressure defined with home blood pressure (BP) measurements remains unclear. METHODS: A prospective nationwide study was initiated in 2000-2001 on 1924 randomly selected participants aged 44-74 years. We determined home and office BP at baseline and classified the individuals into four groups according to their home BP levels: normotension, isolated diastolic hypertension, isolated systolic hypertension and systolic-diastolic hypertension. The primary endpoint was incidence of a composite cardiovascular event. RESULTS: After a median follow-up of 11.2 years, 236 individuals had suffered a cardiovascular event. In multivariable Cox proportional hazard models, the relative hazards and 95% confidence intervals (CIs) for cardiovascular events were significantly higher in participants with isolated diastolic hypertension (relative hazard 1.95; 95% CI, 1.06-3.57; P=0.03), isolated systolic hypertension (relative hazard 2.08; 95% CI, 1.42-3.05; P<0.001) and systolic-diastolic hypertension (relative hazard 2.79; 95% CI, 2.02-3.86; P<0.001) than in participants with normotension. Home (relative hazard 1.21; 95% CI, 1.05-1.40; P=0.009 per 10 mmHg increase), but not office (relative hazard 1.10; 95% CI, 1.00-1.21, P=0.06) pulse pressure, adjusted for mean arterial pressure, was an independent predictor of cardiovascular risk. CONCLUSION: Isolated diastolic and systolic hypertension defined with home measurements are associated with an increased cardiovascular risk. Close follow-up and possible treatment of these patients is therefore warranted. Home-measured pulse pressure is an independent predictor of cardiovascular events while office-measured pulse pressure is not, which fortifies the view that home BP provides more accurate risk prediction than office BP.