Prognostic Value of the Variability in Home-Measured Blood Pressure and Heart Rate: The Finn-Home Study

• Published in: Hypertension (Dallas, Tex. 1979) Tex. 1979), 2012-02, Vol.59 (2), p.212-218
• Main Authors: Johansson, Jouni K, Niiranen, Teemu J, Puukka, Pauli J, Jula, Antti M
• Format: Article
• Language: English
• Subjects: Aged; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - physiology; Blood Pressure Monitoring, Ambulatory; Cardiology. Vascular system; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - physiopathology; Circadian Rhythm - physiology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Female; Finland; Follow-Up Studies; Heart Rate - physiology; Humans; Male; Medical sciences; Middle Aged; Monitoring, Ambulatory; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Reproducibility of Results; Retrospective Studies; Risk Factors
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.111.178657

The objective of the study was to assess the prognostic value of variability in home-measured blood pressure (BP) and heart rate (HR) in a general population. We studied a representative sample of the Finnish adult population with 1866 study subjects aged 45–74 years. BP and HR self-measurements were performed on 7 consecutive days. The variabilities of BP and HR were defined as the SDs of morning minus evening, day-by-day, and first minus second measurements. The primary end point was incidence of a cardiovascular event. The secondary end point was total mortality. During a follow-up of 7.8 years, 179 subjects had experienced a cardiovascular event, and 130 subjects had died. In Cox proportional hazard models adjusted for age, sex, BP/HR, and other cardiovascular risk factors, morning-evening home BP variability (systolic/diastolic relative hazard1.04/1.10 [95% CI1.01–1.07/1.05–1.15] per 1-mm Hg increase in BP variability) and morning day-by-day home BP variability (relative hazard1.04/1.10 [95% CI1.00–1.07/1.04–1.16] per 1-mm Hg increase in BP variability) were predictive of cardiovascular events. Morning-evening home HR variability (relative hazard1.07 [95% CI1.02–1.12] per 1-bpm increase in HR variability) and morning day-by-day home HR variability (relative hazard1.11 [95% CI1.05–1.17] per 1-bpm increase in HR variability) were also independent predictors of cardiovascular events. Greater variabilities of morning home BP and HR are independent predictors of cardiovascular events. Because the variabilities of home BP and HR are easily acquired in conjunction with home BP and HR level, they should be used as the additive information in the assessment of cardiovascular risk.