Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement

TLDR

The study aimed to compare the predictive power of home versus screening blood pressure measurements for mortality. A prospective cohort of 1,789 adults aged ≥40 years was followed for a mean of 6.6 years, with home and screening BP measured and analyzed by Cox regression adjusted for age, sex, smoking, prior cardiovascular disease, and antihypertensive use. Home systolic BP, particularly the average of multiple readings, was a stronger predictor of cardiovascular mortality than screening BP, marking the first direct comparison of their prognostic significance.

Abstract

Objective To compare the predictive powers of self-measurement of blood pressure at home (home blood pressure measurement) and casual (screening) blood pressure measurement for mortality. Design A prospective cohort study. Subjects and methods We obtained home and screening blood pressure measurements for 1789 subjects aged ≥ 40 years who were followed up for a mean of 6.6 years. The prognostic significance of blood pressure for mortality was determined by the Cox proportional hazards regression model adjusted for age, sex, smoking status, past history of cardiovascular disease, and the use of antihypertensive medication. Results When the home blood pressure values and the screening blood pressure values were simultaneously incorporated into the Cox model as continuous variables, only the average of multiple (taken more than three times) home systolic blood pressure values was significantly and strongly related to the cardiovascular mortality risk. The average of the two initial home blood pressure values was also better related to the mortality risk than were the screening blood pressure values. Conclusions Home blood pressure measurement had a stronger predictive power for mortality than did screening blood pressure measurement for a general population. This appears to be the first study in which the prognostic significances of home and screening blood pressure measurements have been compared.