Home blood pressure and cardiovascular risk in treated hypertensive patients: the prognostic value of the first and second measurements and the difference between them in the HONEST study

摘要

Hypertension guidelines recommend using the average of two home blood pressure (HBP) measurements obtained on one occasion to monitor blood pressure. We studied the prognostic value of the first and second measurements or their average value during the follow-up period, as well as the relationships among the difference between the first and second HBP measurements and the prognosis using data from the HONEST (HBP measurement with Olmesartan-Naive patients to Establish Standard Target blood pressure) study. During the mean 2.02 years follow-up, 280 patients had cardiovascular events. Hazard ratios (HRs) for cardiovascular events for each 1 mm Hg increase in the first, second and averaged morning home systolic blood pressure (MHSBP) were similar. Hazards were significantly higher in patients with a large difference between the first and second MHSBP (Delta MHSBP) of < -5 mm Hg (HR: 2.12) or >= 5 mm Hg (HR: 1.44) compared with those with a small Delta MHSBP of >= -5 to <5 mm Hg using the Cox proportional hazards model adjusted for the averaged MHSBP during the follow-up and other risk factors. Hazards in patients with an averaged MHSBP >= 145 mmHg and a small Delta MHSBP (HR: 3.11), those with an averaged MHSBP >= 125 to <145 mm Hg and a large Delta MHSBP (HR: 1.91) and those with an averaged MHSBP >= 145 mm Hg and a large Delta MHSBP (HR: 4.63) were higher compared with those with an averaged MHSBP <125 mm Hg and a small.MHSBP. In conclusion, the first, second and averaged MHSBP measurements have similar prognostic values. Prognosis is worse for patients with a large Delta MHSBP. In clinical practice, it would be prudent to measure the HBP two times and use the average HBP of two measurements obtained on one occasion with particular attention to patients with a large Delta MHSBP.