Outcome-Driven Thresholds for Home Blood Pressure Measurement: International Database of HOme blood pressure in relation to Cardiovascular Outcome

• Published in: Hypertension (Dallas, Tex. 1979) Tex. 1979), 2013-01, Vol.61 (1), p.27-34
• Main Authors: Niiranen, Teemu J, Asayama, Kei, Thijs, Lutgarde, Johansson, Jouni K, Ohkubo, Takayoshi, Kikuya, Masahiro, Boggia, José, Hozawa, Atsushi, Sandoya, Edgardo, Stergiou, George S, Tsuji, Ichiro, Jula, Antti M, Imai, Yutaka, Staessen, Jan A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antihypertensive Agents - therapeutic use; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - physiology; Blood Pressure Monitoring, Ambulatory; Cardiology. Vascular system; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - physiopathology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Databases, Factual; Female; Humans; Hypertension - drug therapy; Hypertension - epidemiology; Hypertension - physiopathology; Incidence; Male; Medical sciences; Middle Aged; Prognosis; Risk Factors; Surveys and Questionnaires
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.111.00100

The lack of outcome-driven operational thresholds limits the clinical application of home blood pressure (BP) measurement. Our objective was to determine an outcome-driven reference frame for home BP measurement. We measured home and clinic BP in 6470 participants (mean age, 59.3 years; 56.9% women; 22.4% on antihypertensive treatment) recruited in Ohasama, Japan (n=2520); Montevideo, Uruguay (n=399); Tsurugaya, Japan (n=811); Didima, Greece (n=665); and nationwide in Finland (n=2075). In multivariable-adjusted analyses of individual subject data, we determined home BP thresholds, which yielded 10-year cardiovascular risks similar to those associated with stages 1 (120/80 mm Hg) and 2 (130/85 mm Hg) prehypertension, and stages 1 (140/90 mm Hg) and 2 (160/100 mm Hg) hypertension on clinic measurement. During 8.3 years of follow-up (median), 716 cardiovascular end points, 294 cardiovascular deaths, 393 strokes, and 336 cardiac events occurred in the whole cohort; in untreated participants these numbers were 414, 158, 225, and 194, respectively. In the whole cohort, outcome-driven systolic/diastolic thresholds for the home BP corresponding with stages 1 and 2 prehypertension and stages 1 and 2 hypertension were 121.4/77.7, 127.4/79.9, 133.4/82.2, and 145.4/86.8 mm Hg; in 5018 untreated participants, these thresholds were 118.5/76.9, 125.2/79.7, 131.9/82.4, and 145.3/87.9 mm Hg, respectively. Rounded thresholds for stages 1 and 2 prehypertension and stages 1 and 2 hypertension amounted to 120/75, 125/80, 130/85, and 145/90 mm Hg, respectively. Population-based outcome-driven thresholds for home BP are slightly lower than those currently proposed in hypertension guidelines. Our current findings could inform guidelines and help clinicians in diagnosing and managing patients.