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Home versus office blood pressure

longitudinal relations with left ventricular hypertrophy

the Finn-Home study

Sivén, Sam S.E.; Niiranen, Teemu J.; Langén, Ville L.J.; Puukka, Pauli J.; Kantola, Ilkka M.; Jula, Antti M.

doi: 10.1097/HJH.0000000000001152
ORIGINAL PAPERS: BP measurement
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Objectives: Electrocardiographically assessed left-ventricular hypertrophy (ECG-LVH) is a particularly high-risk phenomenon that is a part of every hypertensive patient's initial work-up. Several cross-sectional studies have demonstrated that home blood pressure (BP) has a stronger relation to LVH than office BP. However, longitudinal evidence on the association between home BP and target organ damage is scarce to nonexistent.

Methods: We studied in a sample of 615 community-dwelling participants (mean age at baseline 53.7 ± 7.2, 58% women) whether change in home BP is more strongly associated with change in ECG-LVH than change in office BP over an 11-year follow-up.

Results: Pearson's correlation coefficients between changes in home/office SBP and changes in Sokolow–Lyon index, Cornell voltage, Cornell product and R wave amplitude in aVL were 0.21/0.18, 0.28/0.17*, 0.25/0.16*, and 0.32/0.20*, respectively (asterisk indicates P < 0.05 for between-method difference in correlations with Steiger's z test). For change in home/office DBP and change in the aforementioned ECG-LVH indexes, the correlations were 0.12/0.12, 0.20/0.15, 0.16/0.12, and 0.28/0.19*. Multivariable-adjusted regression modelling provided similar results. No clinically significant increase in correlations between home BP and ECG-LVH indexes occurred after the fourth day of home BP measurement.

Conclusion: Our study demonstrates for the first time the superiority of home BP over office BP in the follow-up of left ventricular mass. The results of this and previous studies underline the importance of using out-of-office BP measurements as the primary method for assessing blood pressure levels.

aDepartment of Health, National Institute for Health and Welfare

bUniversity of Turku, Turku, Finland

cFramingham Heart Study, Framingham, Massachusetts, USA

dHeart Centre

eDivision of Medicine, Turku University Hospital, Turku, Finland

Correspondence to Sam S.E. Sivén, Department of Health, National Institute for Health and Welfare, P.O. Box 57, 20521, Kiinamyllynkatu 13, 20520 Turku, Finland. Tel: +358 40 834 3840; fax: +358 29 524 6000; e-mail: ssesiv@utu.fi

Abbreviations: BP, blood pressure; COCOR, Comparing Correlations; ECG-LVH, electrocardiographically assessed left ventricular hypertrophy; RaVL, R wave amplitude in aVL

Received 15 May, 2016

Revised 29 August, 2016

Accepted 16 September, 2016

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