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Relationship Between Home Blood Pressure Monitoring-Confirmed Resistant Hypertension and Cardiovascular Prognosis
Kazuomi Kario1, Yukie Okawara1, Hiroshi Kanegae1
1Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
Hypertension (Dallas, Tex. : 1979)
|October 23, 2025
Summary
Resistant hypertension confirmed by home blood pressure monitoring significantly increases cardiovascular event risk. This risk is highest in patients with a prior history of cardiovascular disease.
Area of Science:
- Cardiology
- Hypertension Research
- Preventive Medicine
Background:
- Drug-resistant hypertension prognosis requires evaluation using both office and home blood pressure readings.
- The Japan Morning Surge-Home Blood Pressure study analyzed cardiovascular events in patients with resistant hypertension.
Purpose of the Study:
- To evaluate the cardiovascular event rate in patients with drug-resistant hypertension defined by home blood pressure monitoring.
- To compare event rates with other hypertension subgroups.
Main Methods:
- Analysis of the Japan Morning Surge-Home Blood Pressure study data.
- Inclusion criteria for true resistant hypertension: office BP ≥140/90 mmHg, home BP ≥135/85 mmHg, on ≥3 antihypertensives including a diuretic.
- Follow-up for cardiovascular events including stroke, coronary artery disease, heart failure, aortic dissection, and sudden death.
Main Results:
- Over 6.2 years, 4278 participants were followed.
- Home blood pressure monitoring-confirmed resistant hypertension showed a significantly higher incidence of cardiovascular events (34.7 per 1000 person-years) compared to well-controlled hypertension (11.9 per 1000 person-years).
- Cardiovascular event incidence was highest in the resistant hypertension group with a prior cardiovascular disease history.
Conclusions:
- Home blood pressure monitoring-confirmed resistant hypertension is linked to a high incidence of cardiovascular events.
- The presence of a cardiovascular disease history further elevates this risk.
- The role of home blood pressure monitoring in defining resistant hypertension and guiding treatment strategies needs further investigation compared to ambulatory blood pressure monitoring.
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