Home blood pressure averaged over 1 week predicted cardiovascular events (systolic HR 1.021 per 1-mm Hg increase; 95% CI 1.012-1.030), with most predictive value achieved in the first 3 days.
Cohort (n=2,081)
Yes
What is the optimal schedule for home blood pressure measurement to predict cardiovascular events in adults aged 45 to 74 years?
Home blood pressure should be measured twice in the morning and evening for at least 3 days, and preferably 7 days, without discarding the first day's values, to optimally predict cardiovascular risk.
Hazard Ratio: 1.021 (95% CI 1.012–1.03)
Current guidelines based on cross-sectional statistical parameters derived from reference populations make equivocal recommendations for the optimal schedule of home blood pressure (BP) measurement. The objective of this study was to determine a schedule for home BP measurements in relation to their predictive value for total cardiovascular risk. Home BP was measured twice every morning and evening for 1 week in an unselected nationwide population of 2081 subjects aged 45 to 74 years. The prognostic significance of BP for fatal and nonfatal cardiovascular events was examined using adjusted Cox proportional hazards regression models. A total of 162 cardiovascular events were recorded during a 6.8-year follow-up. The predictive value of home BP increased progressively with the number of measurements, showing the highest predictive value with the average of all measurements (systolic/diastolic hazard ratio per 1-mm Hg increase in BP: 1.021/1.034; systolic/ diastolic 95% CI: 1.012 to 1.030/1.018 to 1.049). However, most of this increase was achieved during the first 3 days of measurement (hazard ratio: 1.017/1.028; 95% CI: 1.009 to 1.026/1.013 to 1.045), and only minimal increase occurred after day 6. No additional benefit was achieved by discarding the values obtained during the first day of measurement. Morning and evening BPs were equally predictive of future cardiovascular events. Novel prognostic data from this study show that measurement of home BP twice in the morning and evening, preferably for a period of 7 days, or for at least 3 days, provides a thorough image of a patient's BP level. This information should be used to prepare a unified international guideline for home BP measurement.
Niiranen et al. (Tue,) conducted a cohort in Cardiovascular risk (n=2,081). Home blood pressure measurement was evaluated on Fatal and nonfatal cardiovascular events (HR 1.021, 95% CI 1.012-1.030). Home blood pressure averaged over 1 week predicted cardiovascular events (systolic HR 1.021 per 1-mm Hg increase; 95% CI 1.012-1.030), with most predictive value achieved in the first 3 days.