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Comparison of Home and Ambulatory Blood Pressure Measurements in Association With Preclinical Hypertensive Cardiovascular Damage

Lin, Ting-Tse, MD; Juang, Jimmy Jyh-Ming, MD, PhD; Lee, Jen-Kuang, MD, PhD; Tsai, Chia-Ti, MD, PhD; Chen, Chen-Huan, MD, PhD; Yu, Wen-Chung, MD, PhD; Cheng, Hao-min, MD, PhD; Wu, Yen-Wen, MD, PhD; Chiu, Yu-Wei, MD; Kuo, Chi-Tai, MD, PhD; Chen, Jin-Jer, MD, PhD; Chen, Zhih-Cherng, MD; Chang, Wei-Ting, MD; Liu, Ping-Yen, MD, PhD; Chen, Po-wei, MD; Yen, Hsueh-Wei, MD; Chen, Ying-Chih, MD; Tseng, Wei-Kung, MD, PhD; Chiang, Fu-Tien, MD, PhD; Wu, Cho-Kai, MD, PhD Taiwan Hypertension-Associated Cardiac Disease Consortium

Journal of Cardiovascular Nursing: March/April 2019 - Volume 34 - Issue 2 - p 106–114
doi: 10.1097/JCN.0000000000000515
ARTICLES: Risk Detection and Reduction
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Objective: To evaluate whether home or ambulatory blood pressure (BP) monitoring was associated with preclinical hypertensive cardiovascular target organ damage (TOD).

Methods: We enrolled participants with prehypertension and stage 1 hypertension from 11 medical centers within the Taiwan hypertension-associated cardiac disease consortium. Recordings of clinical BP measurement, ambulatory BP monitoring for 24 hours, and home BP monitoring during morning and evening were made. The measured parameters of target organ damage included left ventricular mass index (LVMI), left atrial volume index (LAVI), and carotid-femoral pulse wave velocity (PWV).

Results: Data were collected from 561 study participants (mean age, 65.0 ± 10.8 years; men, 61.3%). Morning and evening home BP values were slightly higher than the daytime and nighttime ABP values (difference for systolic morning-daytime/evening-nighttime, 7.3 ± 14.2/11.3 ± 18.5 mm Hg, P < .001; for diastolic, 5.4 ± 9.4/7.3 ± 12.1, P < .001). Daytime ambulatory (r = 0.114), nighttime ambulatory (r = 0.130), morning home (r = 0.310), and evening home (r = 0.220) systolic BPs (SBPs) were all associated with LVMI (all P < .05). The correlation coefficient was significantly greater for the relationship between daytime home SBP and LVMI than for the relationship between ambulatory SBP and LVMI (P < .01). The goodness of fit of the association between SBP and LVMI improved by adding home daytime SBP to the other SBPs (P < .001). Similar findings were observed for LAVI, but not for PWV.

Conclusion: These findings indicate that morning SBP assessed by home monitoring appears to be a better predictor than other BP measures to determine preclinical hypertensive cardiovascular damage in patients with early-stage hypertension.

Ting-Tse Lin, MD Lecturer, Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Hsin-Chu Branch; and Institute of Biomedical Engineering, National Chiao-Tung University, Hsinchu, Taiwan.

Jimmy Jyh-Ming Juang, MD, PhD Associate Professor, Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.

Jen-Kuang Lee, MD, PhD Lecturer, Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.

Chia-Ti Tsai, MD, PhD Professor, Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.

Chen-Huan Chen, MD, PhD Professor, Division of Cardiology, Department of Medical Education, Taipei Veterans General Hospital, Taiwan.

Wen-Chung Yu, MD, PhD Associate Professor, Department of Medicine, National Taiwan University Hospital; and Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Hao-min Cheng, MD, PhD Associate Professor, Department of Medicine, National Taiwan University Hospital; and Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Yen-Wen Wu, MD, PhD Professor, Cardiology Division of Cardiovascular Medical Center and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.

Yu-Wei Chiu, MD Assistant Professor, Department of Computer Science and Engineering, Yuan Ze University, Taiwan.

Chi-Tai Kuo, MD, PhD Professor, Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Jin-Jer Chen, MD, PhD Professor, China Medical University Hospital, Taichung, Taiwan.

Zhih-Cherng Chen, MD Associate Professor, Chi Mei Medical Center, Tainan, Taiwan.

Wei-Ting Chang, MD Assistant Professor, Chi Mei Medical Center, Tainan, Taiwan.

Ping-Yen Liu, MD, PhD Professor, Division of Cardiology, Internal Medicine, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.

Po-wei Chen, MD Attending Physician, Division of Cardiology, Internal Medicine, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.

Hsueh-Wei Yen, MD Lecturer, Division of Cardiology, Kaohsiung Medical University Hospital, Taiwan.

Ying-Chih Chen, MD Attending Physician, Division of Cardiology, Kaohsiung Medical University Hospital, Taiwan.

Wei-Kung Tseng, MD, PhD Assistant Professor, Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.

Fu-Tien Chiang, MD, PhD Professor, Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.

Cho-Kai Wu, MD, PhD Associate Professor, Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.

The Taiwan Biospecimen Bank and Consortium of Hypertension-associated Cardiac Disease (TCHC) includes 11 medical centers in Taiwan and is a nonprofit research alliance focusing on hypertension and hypertension-related disease clinical trials and research collaboration. The TCHC was founded under the auspices of the Ministry of Science and Technology, Republic of China. Details of the consortium and its purpose, vision, and goals are reported on the website (http://tc2.ntu.edu.tw/en/tchc/intro).

Author Contributions T.T.L. drafted this article, and J.J.M. and J.K.L. enrolled the cohort and data. C.H.C., W.C.Y., H.M.C., Y.W.W., Y.W.C., C.T.K., J.J.C., Z.C.C., W.T.C., P.Y.L., P.W.C., H.W.Y., Y.C.C., and W.K.T. enrolled patients and collected data. C.T.T. and F.T.C. performed statistical analyses. C.K.W. and F.T.C. designed this study, and C.K.W. was responsible for the interpretation of data.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jcnjournal.com).

Correspondence Cho-Kai Wu, MD, PhD, Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan S Rd, Taipei 100, Taiwan (ttlin111@ntu.edu.tw).

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