title: Predictive power of home blood pressure and clinic blood pressure in hypertensive patients with impaired glucose metabolism and diabetes.
abstract: OBJECTIVE
  We evaluated the predictive power of home blood pressure and clinic blood pressure based on the long-term cardiovascular outcome in hypertensive patients with and without impaired glucose metabolism (IGM).
  
  
  METHODS
  The multicentre Hypertension Objective Treatment Based on Measurement by Electrical Devices Blood Pressure trial (HOMED-BP) involved 3080 patients (50.5% women; mean age 59.7 years) with a baseline, untreated home/clinic blood pressure as well as follow-up, on-treatment blood pressure. Of those, 979 had IGM and 475 of these patients had diabetes. We applied Cox regression pooling all participants in a cohort analysis in which IGM and normal glucose metabolism (NGM) were separated.
  
  
  RESULTS
  During median 5.45 years follow-up, cardiovascular events occurred in 48 patients with IGM and 53 patients with NGM. Baseline home SBP significantly predicted cardiovascular outcome among IGM group [hazard ratio 1.68, 95% CI 1.26-2.26, P = 0.0005]. On-treatment home blood pressure was a significant predictor for cardiovascular risk even after the further adjustment of baseline blood pressure level (P ≤ 0.027), whereas on-treatment clinic blood pressure was not in NGM group (P ≥ 0.37). The event rate in IGM was approximately two times higher than that in NGM (9.95 vs. 4.88 per 1000 patient-years), resulted to the low 5-year number needed to treat in IGM patients [83 vs. 121 for 1-SD (13.1 mmHg) home SBP reduction, and 62 vs. 104 for 1-SD (9.5 mmHg) home DBP reduction).
  
  
  CONCLUSIONS
  The present findings suggest that long-term cardiovascular risk in IGM patients should be assessed based on home blood pressure, not on clinic blood pressure.
authors.affiliation: Department of Endocrinology and Diabetes, School of Medicine, Saitama Medical University, Moroyama, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Noguchi
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
authors.forename: Munemichi
authors.initials: M
authors.lastname: Inaba
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Miki
authors.initials: M
authors.lastname: Hosaka
authors.forename: Michihiro
authors.initials: M
authors.lastname: Satoh
authors.forename: Kei
authors.initials: K
authors.lastname: Kamide
authors.forename: Takuya
authors.initials: T
authors.lastname: Awata
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Katayama
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination / Q000379:methods*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology*; D007564:Japan; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012648:Self Care; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D005947:Glucose