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Evidence summaries

Home Blood Pressure (Bp) Measurement Compared to Office Bp

Home blood pressure (BP) measurements may better predict cardiovascular morbidity and mortality than office BP. Home BP measurements produce lower readings than office-based measurements. Level of evidence: "C"

A prospective nationwide study 1 included 2 081 randomly selected subjects aged 45 to 74 years. Home and office blood pressure (BP), and other cardiovascular risk factors were determined at baseline. After a mean follow-up of 6.8 years, 162 subjects had experienced a cardiovascular event (cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, percutaneous coronary intervention, or coronary artery bypass graft surgery), and 118 subjects had died. In Cox proportional hazard models adjusted for other cardiovascular risk factors, office BP and home BP were predictive of cardiovascular events. When both BPs were simultaneously included in the models, only home BP, not office BP was predictive of cardiovascular events. Systolic home BP was the sole predictor of total mortality. These findings suggest that home-measured BP is prognostically superior to office BP.

A systematic review and meta-analyses 2 included 8 prospective studies with a total of 17 698 subjects with a follow-up of 3.2 to 10.9 years. For all-cause mortality (n = 747) the hazard ratio (HR) for home BP was 1.14 (95% CI 1.01 to 1.29) per 10 mmHg increase in systolic BP compared to 1.07 (0.91 to 1.26) for office BP. For cardiovascular mortality (n = 193) the HR for home BP was 1.29 (1.02 to 1.64) per 10 mmHg increase in systolic BP compared to 1.15 (0.91 to 1.46) for office BP. For cardiovascular events (n = 699) the HR for home BP was 1.14 (1.09 to 1.20) per 10 mmHg increase in systolic BP compared to 1.10 (1.06 to .15) for office BP. In 3 studies which adjusted for office and home BP the HR was 1.20 (1.11 to 1.30) per 10 mmHg increase in systolic BP for home BP adjusted for office BP compared to 0.99 (0.93 to 1.07) per 10 mmHg increase in systolic BP for office BP adjusted for home BP.

A study 3 to determine outcome-driven references for home blood pressure (BP) measurements included a total of 6 470 subjects from Japan, Uruguay, Greece, and Finland with a median follow-up of 8.3 years. The mean age of participants was 59.3 years, 56.9% were women, and 22.4% were on antihypertensive treatment. 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 were determined in multivariable-adjusted analyses of individual subject data. Rounded home blood pressure thresholds for stages 1 and 2 prehypertension and stages 1 and 2 hypertension were 120/75, 125/80, 130/85, and 145/90 mm Hg, respectively.

    References

    • Niiranen TJ, Hänninen MR, Johansson J et al. Home-measured blood pressure is a stronger predictor of cardiovascular risk than office blood pressure: the Finn-Home study. Hypertension 2010;55(6):1346-51. [PubMed]
    • Ward AM, Takahashi O, Stevens R et al. Home measurement of blood pressure and cardiovascular disease: systematic review and meta-analysis of prospective studies. J Hypertens 2012;30(3):449-56. [PubMed]
    • Niiranen TJ, Asayama K, Thijs L et al. Outcome-driven thresholds for home blood pressure measurement: international database of home blood pressure in relation to cardiovascular outcome. Hypertension 2013;61(1):27-34. [PubMed]

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