Prognostic significance of on-treatment home and clinic blood pressure for predicting cardiovascular events in hypertensive patients in the HONEST study.
We investigated the prognostic significance of morning home SBP (MHSBP) and clinic SBP (CSBP) at baseline and during follow-up in on-treatment hypertensive patients.



In the Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure study, more than 20 000 Japanese hypertensive patients who started treatment with olmesartan were followed for cardiovascular events for 2 years. MHSBP and CSBP measured at baseline and during follow-up were compared in terms of the prognostic significance in predicting cardiovascular events.



The analysis included 21 591 patients (50.6% female; average age 64.9 years; mean follow-up 2.02 years; and 280 cardiovascular events). The mean MHSBP and CSBP were 151.2 and 153.6 mmHg at baseline and 135.2 and 135.2 mmHg during follow-up. Hazard ratios per 1 mmHg increase were 1.011 (95% confidence interval 1.004-1.019) and 1.006 (1.000-1.012) at baseline, and 1.039 (1.029-1.049) and 1.026 (1.016-1.036) during follow-up. When MHSBP and CSBP at baseline and during follow-up were included in the same model, only MHSBP during follow-up was identified as a significant predictive factor. The concordance index of all blood pressure variables showed reasonable discrimination abilities, and that of mean during follow-up were higher than that of SBP at baseline. The results of net reclassification improvement analyses showed that follow-up MHSBP had better reclassification ability than follow-up CSBP.



SBP during follow-up (as compared with SBP at baseline), particularly MHSBP (as compared with CSBP), had better prognostic significance in predicting cardiovascular events in Japanese hypertensive patients during a 2-year clinical study.
aShin-Oyama City Hospital bDivision of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi cThe Life Planning Center Foundation, Tokyo dDepartment of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto eDaiichi Sankyo Co., Ltd., Tokyo fKeio University, Kanagawa, Japan.
Kazuyuki
K
Shimada
Kazuomi
K
Kario
Toshio
T
Kushiro
Satoshi
S
Teramukai
Natsuko
N
Zenimura
Yusuke
Y
Ishikawa
Yasuyuki
Y
Okuda
Ikuo
I
Saito
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007093:Imidazoles / Q000627:therapeutic use; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D011379:Prognosis; D012648:Self Care; D013777:Tetrazoles / Q000627:therapeutic use
D000959:Antihypertensive Agents; D007093:Imidazoles; D013777:Tetrazoles; C437965:olmesartan