title: Incorporating self-blood pressure measurements at home in the guideline from the Ohasama study.
abstract: 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.
authors.affiliation: 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
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kikuya
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.forename: Hirohito
authors.initials: H
authors.lastname: Metoki
authors.forename: Azusa
authors.initials: A
authors.lastname: Hara
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Inoue
authors.forename: Taku
authors.initials: T
authors.lastname: Obara
authors.forename: Takuo
authors.initials: T
authors.lastname: Hirose
authors.forename: Rieko
authors.initials: R
authors.lastname: Hatanaka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hozawa
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Hoshi
authors.forename: Junichiro
authors.initials: J
authors.lastname: Hashimoto
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Totsune
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Satoh
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
mesh_terms: 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