title: Home, automated office, and conventional office blood pressure as predictors of cardiovascular risk.
abstract: Automated office blood pressure (AOBP) has recently been shown to closely predict cardiovascular (CV) events in the elderly. Home blood pressure (HBP) has also been accepted as a valuable method in the prediction of CV disease. This study aimed to compare conventional office BP (OBP), HBP, and AOBP in order to evaluate their value in predicting CV events and deaths in hypertensives. We assessed 236 initially treatment naïve hypertensives, examined between 2009 and 2013. The end points were any CV and non-CV event including mortality, myocardial infarction, coronary heart disease, hospitalization for heart failure, severe arrhythmia, stroke, and intermittent claudication. We fitted proportional hazards models using the different modalities as predictors and evaluated their predictive performance using three metrics: time-dependent receiver operating characteristics curves, the Akaike's Information Criterion, and Harrell's C-index. After a mean follow-up of 7 years, 23 participants (39% women) had experienced ≥1 CV event. Conventional office systolic (hazard ratio [HR] per 1 mm Hg increase in BP, 1.028; 95% confidence interval [CI], 1.009-1.048), automated office systolic (HR per 1 mm Hg increase in BP, 1.031; 95% CI, 1.008-1.054), and home systolic (HR, 1.025; 95% CI, 1.003-1.047) were predictive of CV events. All systolic BP measurements were predictive after adjustment for other CV risk factors (P < .05). The predictive performance of the different modalities was similar. Conventional OBP was significantly higher than AOBP and average HBP. AOBP predicts equally well to OBP and HBP CV events. It appears to be comparable to HBP in the assessment of CV risk, and therefore, its introduction into guidelines and clinical practice as the reference method for assessing BP in the office seems reasonable after verification of these findings by randomized trials.
authors.affiliation: Hypertension and Cardiovascular Disease Prevention Outpatient Center, Evangelismos General Hospital, Athens, Greece; Fourth Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece. Electronic address: andreadise@usa.net.
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Andreadis
authors.affiliation: Department of Cardiology, Veterans Affairs and Georgetown University Medical Centers, Washington, DC, USA.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
authors.affiliation: Hypertension and Cardiovascular Disease Prevention Outpatient Center, Evangelismos General Hospital, Athens, Greece; Fourth Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece.
authors.forename: Charalampia V
authors.initials: CV
authors.lastname: Geladari
authors.affiliation: Hypertension and Cardiovascular Disease Prevention Outpatient Center, Evangelismos General Hospital, Athens, Greece.
authors.forename: George N
authors.initials: GN
authors.lastname: Kolyvas
authors.affiliation: Hypertension and Cardiovascular Disease Prevention Outpatient Center, Evangelismos General Hospital, Athens, Greece.
authors.forename: Epameinondas T
authors.initials: ET
authors.lastname: Angelopoulos
authors.affiliation: Department of Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Aronis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods* / Q000592:standards; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors
keywords: Automated office blood pressure; cardiovascular events; home blood pressure; hypertension