Current diagnostic thresholds for home blood pressure mainly rely on statistical parameters derived from reference populations. We determined an outcome-driven reference frame for home blood pressure measurement.
Home blood pressure was measured in 6470 participants enrolled in prospective general population studies in Ohasama, Japan; Montevideo, Uruguay; Tsurugaya, Japan; Didima, Greece; and nationwide in Finland. In multivariable analyses, we determined home blood pressure thresholds, which yielded 10-year cardiovascular risks similar to those associated with stage 1 prehypertension (120/80 mm Hg), stage 2 prehypertension (130/85 mmHg), stage 1 hypertension (140/90 mm Hg) and stage 2 hypertension (160/100 mmHg) on clinic measurement.
Over 8.3 years (median), 716 cardiovascular end points occurred, including 294 cardiovascular deaths, 393 strokes and 336 cardiac events. Blood pressure was a highly significant predictor of cardiovascular outcome, irrespective of the type of measurement. After excluding the 1452 treated hypertensives at baseline to avoid the confounding effect of the time of blood pressure measurement in relation to drug intake, the systolic/diastolic thresholds for stage 1 and 2 prehypertension, and stage 1 and 2 hypertension were 118.5/76.9, 125.2/79.7, 131.9/82.4 and 145.3/87.9 mmHg, respectively. Rounded thresholds for stage 1 and 2 prehypertension, and stage 1 and stage 2 hypertension amounted to 120/75, 125/80, 130/80, and 145/90 mmHg, respectively.
Population-based outcome-driven thresholds for home blood pressure are lower than those currently proposed by hypertension guidelines. The results of these analyses should inform guidelines and be of help to clinicians involved in the management of patients with hypertension.
© 2012 Lippincott Williams & Wilkins, Inc.