Ambulatory Versus Home Blood Pressure Monitoring in Chinese Outpatients

BACKGROUND: Current hypertension guidelines recommend either ambulatory or home blood pressure (BP) monitoring for the management of hypertension. How we should properly utilize these 2 out-of-office BP measurement techniques remains under investigation. OBJECTIVES: The purpose of this study was to investigate ambulatory and home BP monitoring in the definition of BP phenotypes with regard to cardiovascular outcomes. METHODS: In a nationwide prospective cohort, baseline observations were collected from August 2009 to October 2017, with last follow-ups in July 2024. RESULTS: Among 4,935 participants (mean age 54.3 years), median follow-up time was 4.9 years. The incidence rate of all cardiovascular events (n = 256), stroke (n = 100), and cardiac events (n = 171) was significantly (P ≤ 0.001) higher in 2,894 treated (14.9, 5.9, and 9.7 per 1,000 person-years, respectively) than 2,041 untreated outpatients (4.5, 1.4, and 3.2 per 1,000 person-years, respectively). In untreated patients, the analyses adjusted for confounders and mutually one for another out-of-office BP measurement technique showed that ambulatory but not home (masked and sustained) hypertension was associated with a higher risk of cardiac events relative to normotension (HR: 9.01; 95% CI: 1.10-73.91; and HR: 9.74; 95% CI: 1.01-94.25, respectively). In treated patients, the similarly adjusted analyses showed that home but not ambulatory sustained uncontrolled hypertension was associated with a higher risk of all cardiovascular events (HR: 1.80; 95% CI: 1.12-2.92; P = 0.02) and stroke (HR: 2.32; 95% CI: 1.00-5.42; P = 0.05) relative to controlled hypertension. CONCLUSIONS: Our study in young and middle-aged outpatients indicates a preferable role of ambulatory and home BP monitoring, respectively, in untreated and treated patients in cardiovascular prediction.