Home BP better prognostic tool than office BP
MedWire News: Home measurement of blood pressure (BP) may be a better prognostic variable than office measurement, say a group of researchers.
This finding is in line with European Society of Hypertension guidelines and the American Heart Association, American Society for Hypertension, and Preventive Cardiovascular Nurses Association recommendations for BP monitoring at home, explain Alison Ward (University of Oxford, UK) and colleagues.
Their meta-analysis, reported in the Journal of Hypertension, included eight studies and 17,698 participants. The length of the studies ranged from 3.5 to 10.9 years.
Five studies reported on all-cause mortality outcomes. The combined hazard ratio based on 747 events in 12,046 people was 1.14 per 10 mmHg increase in systolic BP (SBP) for home BP, compared with 1.07 per 10 mmHg increase based on 613 events in 10,860 events for office SBP.
Three studies reported on cardiovascular mortality. The combined hazard ratio based on 193 events in 8779 people was 1.29 per 10 mmHg increase in SBP for home BP, compared with 1.15 per 10 mmHg increase for office BP.
Five studies reported on cardiovascular events including nonfatal myocardial infarction, nonfatal stroke, transient ischemic attack, hospitalization for angina or heart failure, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery. The combined hazard ratio based on 699 events in 12,669 people was 1.14 and 1.10 per 10 mmHg increase in SBP for home and office BP, respectively.
In three studies that adjusted for office and home BP, the hazard ratio was 1.20 per 10 mmHg increase in SBP for home BP adjusted for office BP, compared with 0.99 per 10 mmHg increase in SBP for office BP adjusted for home BP.
Results for diastolic BP were similar, note the authors.
"The results of the combined analysis found that home BP significantly predicted all-cause mortality and cardiovascular mortality, whereas results for office BP were not significant," they write.
"Further, home BP (both systolic and diastolic) remained a significant predictor of cardiovascular mortality and cardiovascular events after adjusting for office BP suggesting it is an important prognostic variable over and above that of office BP."
Ward et al conclude that "at least one ongoing study" should be conducted to provide further data and more conclusive evidence of the prognostic value of home BP measurement.
MedWire (http://www.medwire-news.md/) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Piriya Mahendra