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Peak home blood pressure as an earlier and strong novel risk factor for stroke: the practitioner-based nationwide

Kazuomi Kario1, Naoko Tomitani2, Takeshi Fujiwara2

  • 1Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. kkario@jichi.ac.jp.

Hypertension Research : Official Journal of the Japanese Society of Hypertension
|April 19, 2023
PubMed

Insights

Peak home blood pressure (BP) is a significant predictor of stroke and cardiovascular events. Exaggerated peak home systolic BP (SBP) over 175 mmHg is a novel, early risk factor for stroke.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Preventive Medicine

Background:

  • Home blood pressure (BP) monitoring is crucial for hypertension management.
  • The clinical significance of peak home BP values remains understudied.
  • Understanding peak BP's role can improve cardiovascular event prediction.

Purpose of the Study:

  • To investigate the association between peak home BP thresholds and frequency with cardiovascular events.
  • To identify pathological thresholds for peak home systolic BP (SBP) and stroke risk.
  • To evaluate peak home BP as a novel risk factor for stroke and atherosclerotic cardiovascular disease (ASCVD).

Main Methods:

  • Analysis of data from the Japan Morning Surge-Home Blood Pressure (J-HOP) study (2005-2018).
  • Inclusion of 4231 patients with at least one cardiovascular risk factor.
  • Calculation of average peak home SBP from 14-day measurements and risk assessment for stroke and CAD over a 6.2-year follow-up.

Main Results:

  • The highest quintile of average peak home SBP showed significantly increased risk for stroke (HR 4.39) and ASCVD (HR 2.04).
  • Stroke risk was particularly elevated within the first 5 years (HR 22.66).
  • A pathological threshold of 176 mmHg for average peak home SBP was identified for 5-year stroke risk, with a linear association observed for SBP > 175 mmHg and stroke risk.

Conclusions:

  • Elevated peak home BP, particularly average peak SBP > 175 mmHg, is a strong and early risk factor for stroke.
  • This finding highlights the importance of monitoring peak home BP values for cardiovascular risk assessment.
  • Exaggerated peak home SBP may serve as a novel, predictive marker for stroke, especially in the initial years post-measurement.

Keywords:
Blood pressure variabilityCardiovascular riskHome blood pressurePrognosisStroke

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