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Home Blood Pressure Variability Risk Prediction Score for Cardiovascular Disease Using Data From the J-HOP Study
Kazuomi Kario1, Hiroshi Kanegae1,2, Yukie Okawara1
1Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., H.K., Y.O., N.T., S.H.).
Insights
A new cardiovascular risk score incorporating home blood pressure variability improves prediction accuracy. This simple algorithm can aid hypertension management in clinical practice.
Area of Science:
- Cardiology
- Hypertension Research
- Predictive Analytics
Background:
- Home blood pressure (BP) monitoring is more indicative of cardiovascular event risk than office BP measurements.
- Current cardiovascular risk prediction models often lack home BP variability data.
- The Japan Morning Surge-Home Blood Pressure (J-HOP) study provides a foundation for this research.
Purpose of the Study:
- To develop a simple cardiovascular event prediction score that includes home BP variability.
- To assess the utility of home BP variability in enhancing cardiovascular risk prediction.
- To create a practical tool for hypertension management.
Main Methods:
- Utilized data from the J-HOP study, including 4231 patients with extended follow-up.
- Employed Cox proportional hazards models to predict overall cardiovascular risk.
- Included covariates such as age, sex, BP metrics (office and home), and lipid ratios, focusing on average real variability of morning-evening average (MEave) home systolic BP (SBP).
Main Results:
- The inclusion of average real variability of MEave home SBP significantly improved model performance (C statistic, 0.760).
- A risk score was developed, assigning points for age, sex, cardiovascular disease history, HDL cholesterol, mean MEave home SBP, and its variability.
- The model demonstrated excellent goodness of fit with calibration statistics indicating high accuracy.
Conclusions:
- A straightforward cardiovascular disease prediction algorithm incorporating day-by-day home BP variability has been developed.
- This algorithm can be integrated into clinical practice for a home BP-centered hypertension management approach.
- The findings support the clinical utility of home BP variability in assessing cardiovascular risk.
Background:
Home blood pressure (BP) is more closely associated with cardiovascular event risk than office BP, but cardiovascular risk prediction based on home BP variability is lacking. This study developed a simple cardiovascular event prediction score, including home BP variability data, from the J-HOP study (Japan Morning Surge-Home Blood Pressure).
Methods:
The J-HOP study extended follow-up from December 2017 to May 2018 generated the study data set (4231 patients). Cardiovascular events included fatal/nonfatal stroke (n=94), coronary heart disease (n=124), heart failure (n=42), and aortic dissection (n=8). Cox proportional hazards models were used to predict overall cardiovascular risk. Potential covariates included age, sex, body mass index, smoking, history of diabetes, statin use, history of cardiovascular disease, total cholesterol:high-density lipoprotein cholesterol ratio, office systolic BP (SBP), mean of morning-evening average (MEave), home SBP, and average real variability of MEave home SBP. A risk score and models were constructed, and model performance was assessed.
Results:
Model performance was best when average real variability of MEave SBP was included (C statistic, 0.760). The risk score assigns points for age (5-year bands), sex, cardiovascular disease history, high-density lipoprotein cholesterol, mean MEave home SBP, and average real variability of MEave home SBP. Estimated 10-year cardiovascular risk ranged from ≤0.6% (score ≤0) to >32% (score ≥26). Calibration 2 statistics values for the model (2.66) and risk score (5.29) indicated excellent goodness of fit.
Conclusions:
This simple cardiovascular disease prediction algorithm, including day-by-day home BP variability, could be used as part of a home BP-centered approach to hypertension management in clinical practice.
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