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Different Home Blood Pressure Thresholds to Predict Perfect 24-Hour Ambulatory Blood Pressure Control in Treated
Kazuomi Kario1, Naoko Tomitani1, Satoshi Hoshide1
1Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.).
Insights
Home blood pressure (BP) monitoring is key for hypertension management. Stricter home BP control (<125/75 mmHg) better predicts 24-hour ambulatory BP control, especially for nocturnal hypertension.
Area of Science:
- Cardiology
- Hypertension Management
- Digital Health
Background:
- Home blood pressure (BP) monitoring is crucial for effective hypertension management within digital health strategies.
- Current research lacks studies comparing 24-hour BP control status against various home BP control thresholds using a single device.
Purpose of the Study:
- To investigate the relationship between different home BP control thresholds and 24-hour ambulatory BP control status.
- To assess the predictive value of home BP control for overall BP management.
Main Methods:
- Utilized data from the HI-JAMP study involving 2269 participants.
- Employed a validated all-in-one device for office, home (5-day monitoring), and 24-hour ambulatory BP measurements.
- Analyzed ambulatory BP control status based on home BP readings meeting guideline thresholds of <135/85, <130/80, and <125/75 mmHg.
Main Results:
- With home BP <135/85 mmHg, uncontrolled 24-hour, daytime, and nighttime ambulatory BP prevalence was 19.9%, 18.5%, and 33.6%.
- With stricter home BP <130/80 mmHg, these rates decreased to 13.4%, 12.9%, and 26.0%.
- When home BP was strictly controlled to <125/75 mmHg, uncontrolled 24-hour, daytime, and nighttime ambulatory BP prevalence was significantly lower at 7.0%, 9.0%, and 15.3%.
Conclusions:
- Home BP control thresholds can predict 24-hour ambulatory BP control in treated hypertension.
- A significant portion (one-third) experienced uncontrolled nocturnal hypertension even with home BP <135/85 mmHg.
- Achieving a stricter home BP target (<125/75 mmHg) correlated with well-controlled ambulatory BP.
Background:
Home blood pressure (BP) is an important component of digital strategies for hypertension management. However, no studies have used the same device to investigate 24-hour BP control status in relation to different home BP control thresholds.
Methods:
Participants in the general practitioner-based, multicenter HI-JAMP study (Home-Activity Information and Communication Technology-Based Japan Ambulatory Blood Pressure Monitoring Prospective) underwent office BP measurement, then 24-hour ambulatory BP monitoring, then home BP monitoring for 5 days. A validated all-in-one BP monitoring device was used to measure office, home, and ambulatory BP. Baseline data were used to investigate ambulatory BP control status in individuals with well-controlled home BP based on the different guideline thresholds (125/75 mm Hg, 130/80 mm Hg, and 135/85 mm Hg).
Results:
Data from 2269 patients were analyzed. For individuals with well-controlled home BP <135/85 mm Hg (59.5% of the total population), the prevalence of uncontrolled 24-hour (≥130/80 mm Hg), daytime (≥135/85 mm Hg), and nighttime ambulatory BP (≥120/70 mm Hg) was 19.9%, 18.5%, and 33.6%, respectively. Corresponding prevalence rates in the 42.7% of participants with well-controlled home BP <130/80 mm Hg were 13.4%, 12.9%, and 26.0%, and when well-controlled home BP was strictly defined as <125/75 mm Hg (23.9% of the population), prevalence of rates of uncontrolled 24-hour, daytime, and nighttime ambulatory BP were 7.0%, 9.0%, and 15.3%, respectively.
Conclusions:
Home BP control status defined using different thresholds could predict 24-hour ambulatory BP control status in treated hypertension. One-third of individuals still had uncontrolled nocturnal hypertension when home BP was controlled to <135/85 mm Hg, but ambulatory BP was quite well controlled when home BP was <125/75 mm Hg.
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