Ambulatory Versus Home Blood Pressure Monitoring in Chinese Outpatients

Current hypertension guidelines recommend either ambulatory or home blood pressure (BP) monitoring for the management of hypertension. How we should properly utilize these 2 out-of-office BP measurement techniques remains under investigation.

The purpose of this study was to investigate ambulatory and home BP monitoring in the definition of BP phenotypes with regard to cardiovascular outcomes.

In a nationwide prospective cohort, baseline observations were collected from August 2009 to October 2017, with last follow-ups in July 2024.

Among 4,935 participants (mean age 54.3 years), median follow-up time was 4.9 years. The incidence rate of all cardiovascular events (n = 256), stroke (n = 100), and cardiac events (n = 171) was significantly (P ≤ 0.001) higher in 2,894 treated (14.9, 5.9, and 9.7 per 1,000 person-years, respectively) than 2,041 untreated outpatients (4.5, 1.4, and 3.2 per 1,000 person-years, respectively). In untreated patients, the analyses adjusted for confounders and mutually one for another out-of-office BP measurement technique showed that ambulatory but not home (masked and sustained) hypertension was associated with a higher risk of cardiac events relative to normotension (HR: 9.01; 95% CI: 1.10-73.91; and HR: 9.74; 95% CI: 1.01-94.25, respectively). In treated patients, the similarly adjusted analyses showed that home but not ambulatory sustained uncontrolled hypertension was associated with a higher risk of all cardiovascular events (HR: 1.80; 95% CI: 1.12-2.92; P = 0.02) and stroke (HR: 2.32; 95% CI: 1.00-5.42; P = 0.05) relative to controlled hypertension.

Our study in young and middle-aged outpatients indicates a preferable role of ambulatory and home BP monitoring, respectively, in untreated and treated patients in cardiovascular prediction.