To compare home (HBP) vs. clinic (CBP) vs. ambulatory blood pressure (ABP) in terms of their association with hypertension-induced target-organ damage.
A total of 128 untreated subjects (mean age, 50.9±10.8 years, 70 men) with elevated blood pressure (BP) had measurements of CBP (3 visits, oscillometric device Microlife WatchBP Office), HBP (7 days, oscillometric device Microlife WatchBP Home) and ABP (24-hours, oscillometric devices SpaceLabs 90207/90217 or Microlife WatchBP O3). Target-organ damage was assessed by echocardiographic left-ventricular mass index (LVMI), microalbuminuria (MAU) (two first-morning spots) and carotid-femoral pulse-wave velocity (PWV; Complior).
LVMI was correlated with systolic BP (HBP/CBP r = 0.45/0.39 and ABP 24 h/day/night r = 0.29/0.24/0.32, all p < 0.01) and diastolic HBP (r = 0.24, p = 0.01) and nighttime ABP (r = 0.21, p = 0.02). LVMI was also correlated with all pulse pressure (PP) values (home r = 0.37, p < 0.001; clinic r = 0.30, p = 0.001; ambulatory r = 0.24/0.23/0.25, 24 h/day/night, all p = 0.01). MAU was correlated with systolic HBP (r = 0.28, p < 0.01), CBP (r = 0.26, p < 0.01) and daytime ABP (r = 0.23, p = 0.01) and all PP values (home r = 0.34, p < 0.001; clinic r = 0.34, p < 0.001; ambulatory 24 h/day/night r = 0.30/0.33/0.23, all p = 0.01). PWV was correlated only with systolic HBP (r = 0.22, p < 0.05) and all PP values (home r = 0.33, p = 0.001; clinic r = 0.23, p < 0.05; ABP 24 h/day/night r = 0.26/0.24/0.29, all p < 0.05). In stepwise linear-regression models (dependent variables: age, sex, body mass index [BMI], systolic and diastolic CBP, HBP and ABP; entry/removal criteria of F 0.05/0.1), LVMI was predicted only by systolic HBP (p < 0.001) and BMI (p = 0.01). In a similar model for PWV, predictors were systolic HBP (p = 0.03) and age (p = 0.001). Finally, MAU was primarily predicted by systolic HBP (p < 0.01) (entry/removal criteria of F 0.01/0.05).
These data suggest that home BP is more closely associated with hypertension-induced target organ damage compared to office or ambulatory BP measurements.
1Hypertension Center, Third University Dept of Medicine, Sotiria Hospital, Athens, Greece
2Department of Cardiology Laikon Hospital, Athens, Greece