A1 Refereed original research article in a scientific journal
Optimal Schedule for Assessing Home BP Variability: The Finn-Home Study
Authors: Juhanoja EP, Johansson JK, Puukka PJ, Jula AM, Niiranen TJ
Publisher: OXFORD UNIV PRESS
Publication year: 2018
Journal: American Journal of Hypertension
Journal name in source: AMERICAN JOURNAL OF HYPERTENSION
Journal acronym: AM J HYPERTENS
Volume: 31
Issue: 6
First page : 715
Last page: 725
Number of pages: 11
ISSN: 0895-7061
DOI: https://doi.org/10.1093/ajh/hpy030
Abstract
BACKGROUNDCurrent guidelines make no recommendations on the optimal timing or number of measurements for assessing home blood pressure variability (HBPV). Our aim was to elucidate the optimal schedule for measuring HBPV in relation to cardiovascular risk.METHODSIn total, 1,706 Finnish adults (56.5 +/- 8.5 years; 54% women) self-measured their home blood pressure (HBP) twice in the morning and evening during 7 consecutive days. The participants were followed up for cardiovascular events. We examined the association between HBPV (coefficient of variation based on 2 through 7 measurement days) and cardiovascular events using Cox regression models adjusted for HBP and other cardiovascular risk factors.RESULTSDuring a follow-up of 11.8 +/- 3.1 years, 216 cardiovascular events occurred. Systolic morning HBPV based on three (hazard ratio pin 1.039; 95% confidence interval, 1.006-1.074, model c statistic 0.737) through seven (HR, 1.057; 95% confidence interval, 1.012-1.104, model c statistic 0.737) measurement days was significantly associated with cardiovascular events. Agreement in classification to normal vs. increased morning day-to-day HBPV between consecutive measurement days became substantial (kappa = 0.69 for systolic and kappa = 0.68 for diastolic) after the fourth measurement day. The associations of diastolic HBPV, evening HBPV, all-day HBPV, and variability based on first measurements of each measurement occasion, with cardiovascular outcomes were nonsignificant or remained significant only after the sixth measurement day.CONCLUSIONSOur results suggest systolic HBP should be measured twice in the morning for at least 3 days when assessing HBPV. Increasing the number of measurement days from 3 to 7 results in marginal improvement in prognostic accuracy.
BACKGROUNDCurrent guidelines make no recommendations on the optimal timing or number of measurements for assessing home blood pressure variability (HBPV). Our aim was to elucidate the optimal schedule for measuring HBPV in relation to cardiovascular risk.METHODSIn total, 1,706 Finnish adults (56.5 +/- 8.5 years; 54% women) self-measured their home blood pressure (HBP) twice in the morning and evening during 7 consecutive days. The participants were followed up for cardiovascular events. We examined the association between HBPV (coefficient of variation based on 2 through 7 measurement days) and cardiovascular events using Cox regression models adjusted for HBP and other cardiovascular risk factors.RESULTSDuring a follow-up of 11.8 +/- 3.1 years, 216 cardiovascular events occurred. Systolic morning HBPV based on three (hazard ratio pin 1.039; 95% confidence interval, 1.006-1.074, model c statistic 0.737) through seven (HR, 1.057; 95% confidence interval, 1.012-1.104, model c statistic 0.737) measurement days was significantly associated with cardiovascular events. Agreement in classification to normal vs. increased morning day-to-day HBPV between consecutive measurement days became substantial (kappa = 0.69 for systolic and kappa = 0.68 for diastolic) after the fourth measurement day. The associations of diastolic HBPV, evening HBPV, all-day HBPV, and variability based on first measurements of each measurement occasion, with cardiovascular outcomes were nonsignificant or remained significant only after the sixth measurement day.CONCLUSIONSOur results suggest systolic HBP should be measured twice in the morning for at least 3 days when assessing HBPV. Increasing the number of measurement days from 3 to 7 results in marginal improvement in prognostic accuracy.
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