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Office, home, and ambulatory blood pressures as predictors of cardiovascular risk
Insights
Ambulatory blood pressure (BP) monitoring offers superior cardiovascular risk prediction compared to home or office BP measurements. This study found 24-hour ambulatory BP significantly outperformed other methods in forecasting cardiovascular events.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Clinical Epidemiology
Background:
- Ambulatory blood pressure (BP) is considered the gold standard for BP measurement.
- However, its superior association with cardiovascular risk compared to home BP has not been definitively established.
- This study aimed to clarify the prognostic value of different BP measurement methods.
Purpose of the Study:
- To compare the prognostic value of office, home, and 24-hour ambulatory blood pressure (BP) for cardiovascular risk.
- To determine which BP measurement method best predicts cardiovascular events in a long-term follow-up study.
Main Methods:
- 502 participants were examined between 1992-1996, with BP measured via office, home, and ambulatory methods.
- The primary endpoint was a composite of cardiovascular mortality, myocardial infarction, stroke, heart failure hospitalization, and coronary intervention.
- Multivariable-adjusted Cox models and likelihood ratio tests were used to assess prognostic value and model fit.
Main Results:
- After 16.1 years, 70 participants experienced a cardiovascular event.
- Office, home, and 24-hour ambulatory BP were all predictive of cardiovascular events individually.
- When analyzed together, only systolic/diastolic ambulatory BP remained a significant predictor (P=0.002/<0.001).
- Ambulatory BP significantly improved model fit when added to models including office and home BP (χ2=9.0/12.3, P=0.001/<0.001).
Conclusions:
- 24-hour ambulatory blood pressure (BP) measurement demonstrates superior prognostic value for cardiovascular events compared to office or home BP.
- Ambulatory BP monitoring should be considered the preferred method for cardiovascular risk assessment.
- These findings support the clinical utility of ambulatory BP in guiding cardiovascular risk management strategies.
Abstract:
Ambulatory blood pressure (BP) is considered as the gold standard of BP measurement although it has not been shown to be more strongly associated with cardiovascular risk than is home BP. Our objective was to compare the prognostic value of office, home, and ambulatory BP for cardiovascular risk in 502 participants examined in 1992 to 1996. The end point was a composite of cardiovascular mortality, myocardial infarction, stroke, heart failure hospitalization, and coronary intervention. We assessed the prognostic value of each BP in multivariable-adjusted Cox models. The likelihood χ2 ratio value was used to test whether the addition of a BP variable improved the model’s goodness of fit. After a follow-up of 16.1±3.9 years, 70 participants (13.9%) had experienced ≥1 cardiovascular event. Office (systolic/diastolic hazard ratio per 1/1 mm Hg increase in BP, 1.024/1.018; systolic/diastolic 95% confidence interval, 1.009–1.040/0.994–1.043), home (hazard ratio, 1.029/1.028; 95% confidence interval, 1.013–1.045/1.005–1.052), and 24-hour ambulatory BP (hazard ratio, 1.033/1.049; 95% confidence interval, 1.019–1.047/1.023–1.077) were predictive of cardiovascular events. When all 3 BP variables were included in the model simultaneously, only systolic/diastolic ambulatory BP was a significant predictor of cardiovascular events (P=0.002/<0.001). Home systolic/diastolic BP improved the fit of the model only marginally when added to a model including office BP (χ2=3.0/4.0, P=0.09/0.047). Ambulatory BP, however, improved the fit of model more clearly when added to office and home BP (χ2=9.0/12.3, P=0.001/<0.001). Our findings suggest that ambulatory BP is prognostically superior to office and home BP.