Incorporating self-blood pressure measurements at home in the guideline from the Ohasama study.
Recent guidelines for the treatment of hypertension have all emphasized the importance of self-blood pressure (BP) measurements at home (home BP) in clinical applications of practice, research, and epidemiology. In the Ohasama study, a cohort study based on home BP, we have demonstrated several important findings to be incorporated in those guidelines. We demonstrated that home BP more accurately and reliably reflect target organ damage and the prognosis of cardiovascular disease than conventional BP, whereas the predictive value of home BP increased progressively with the number of measurements. Even the initial-first home BP values (one measurement) showed a significantly greater relation with stroke risk than conventional BP values (mean of two measurements). Home BP in the morning (morning BP) and in the evening (evening BP) provide equally useful information for stroke risk, whereas morning hypertension, which is that specifically observed only in the morning, might be a good predicator of stroke, particularly among individuals using anti-hypertensive medication. Home BP increased the predictive power of categorizations of guidelines compared with conventional BP. Heart rate values assessed at home using a device designed for home BP measurement (home heart rate) was significantly associated with the risk of cardiovascular mortality, independent of home BP. We expect that continuous follow-up and further analysis of the Ohasama data would contribute to producing further important findings worth incorporating in future hypertension guidelines.
Ohkubo
Takayoshi
T
Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan. tohkubo@mail.tains.tohoku.ac.jp
Kikuya
Masahiro
M
Asayama
Kei
K
Metoki
Hirohito
H
Hara
Azusa
A
Inoue
Ryusuke
R
Obara
Taku
T
Hirose
Takuo
T
Hatanaka
Rieko
R
Hozawa
Atsushi
A
Hoshi
Haruhisa
H
Hashimoto
Junichiro
J
Totsune
Kazuhito
K
Satoh
Hiroshi
H
Imai
Yutaka
Y
D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000401:mortality; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012648:Self Care / Q000295:instrumentation / Q000379:methods; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control