Home versus office blood pressure: longitudinal relations with left ventricular hypertrophy: the Finn-Home study.

OBJECTIVES: Electrocardiographically assessed left-ventricular hypertrophy (ECG-LVH) is a particularly high-risk phenomenon that is a part of every hypertensive patient's initial work-up. Several cross-sectional studies have demonstrated that home blood pressure (BP) has a stronger relation to LVH than office BP. However, longitudinal evidence on the association between home BP and target organ damage is scarce to nonexistent. METHODS: We studied in a sample of 615 community-dwelling participants (mean age at baseline 53.7 ±â€Š7.2, 58% women) whether change in home BP is more strongly associated with change in ECG-LVH than change in office BP over an 11-year follow-up. RESULTS: Pearson's correlation coefficients between changes in home/office SBP and changes in Sokolow-Lyon index, Cornell voltage, Cornell product and R wave amplitude in aVL were 0.21/0.18, 0.28/0.17, 0.25/0.16, and 0.32/0.20, respectively (asterisk indicates P < 0.05 for between-method difference in correlations with Steiger's z test). For change in home/office DBP and change in the aforementioned ECG-LVH indexes, the correlations were 0.12/0.12, 0.20/0.15, 0.16/0.12, and 0.28/0.19. Multivariable-adjusted regression modelling provided similar results. No clinically significant increase in correlations between home BP and ECG-LVH indexes occurred after the fourth day of home BP measurement. CONCLUSION: Our study demonstrates for the first time the superiority of home BP over office BP in the follow-up of left ventricular mass. The results of this and previous studies underline the importance of using out-of-office BP measurements as the primary method for assessing blood pressure levels.

The association between home vs. ambulatory night-time blood pressure and end-organ damage in the general population.

OBJECTIVE: The aim of this study was to test the agreement between night-time home and night-time ambulatory blood pressure (BP) and to compare their associations with hypertensive end-organ damage for the first time in the general population. METHODS: A population sample of 248 participants underwent measurements for night-time home BP (three measurements on two nights with a timer-equipped home device), night-time ambulatory BP, pulse wave velocity (PWV), carotid intima-media thickness (IMT) and echocardiographic left ventricular mass index (LVMI). RESULTS: No significant or systematic differences were observed between mean night-time ambulatory and home BPs (systolic/diastolic difference: 0.7 ±â€Š7.6/0.2 ±â€Š6.0 mmHg, P = 0.16/0.64). All night-time home and ambulatory BPs were positively correlated with PWV, IMT and LVMI (P < 0.01 for all). No significant differences in Pearson's correlations between end-organ damage and night-time home or ambulatory BP were observed (P ≥ 0.11 for all comparisons using Dunn and Clark's Z), except for a slightly stronger correlation between PWV and ambulatory SBP than for home SBP (r = 0.57 vs. 0.50, P = 0.03). The adjusted R of all multivariable-adjusted models for PWV, IMT or LVMI that included night-time home or ambulatory SBP/DBP were within 2/1%. CONCLUSION: Our study demonstrates that night-time home and ambulatory measurements produce similar BP values that have comparable associations with end-organ damage in the general population even when a clinically feasible measurement protocol is used for measuring night-time home BP. In the future, night-time home BP measurement may offer a feasible and easily accessible alternative to ambulatory monitoring for the measurement of night-time BP.

White-coat and masked hypertension as risk factors for progression to sustained hypertension: the Finn-Home study.

OBJECTIVES: To assess the risk of progression from white-coat hypertension (WCHT) and masked hypertension (MHT) to sustained hypertension (SHT) in a nationwide unselected population sample. METHODS: Both office and home blood pressure (BP), along with other cardiovascular risk factors, were measured in an unselected population sample of 944 participants in 2000 and 2011. We compared the risk of progression to SHT (office BP ≥140/90 mmHg and home BP ≥135/85 mmHg or start of treatment with antihypertensive medication) between 528 participants with normotension (office BP <140/90 mmHg and home BP <135/85 mmHg), 142 participants with WCHT (office BP ≥140/90 mmHg and home BP < 135/85 mmHg), and 63 participants with MHT (office BP < 140/90 mmHg and home BP ≥135/85 mmHg) at baseline. We used the χ test and a multivariable-adjusted log-binomial regression model to evaluate the association between baseline BP categories and incident SHT. RESULTS: During an 11-year follow-up, the rate of progression to SHT increased from normotension (18%) to WCHT (52%) and MHT (73%), P < 0.0001. Progression to SHT became more likely with an increasing baseline home BP category (Ptrend < 0.0001). The multivariable-adjusted relative risks (95% confidence interval) for developing SHT, as compared with normotension, were 2.8 (2.2-3.6, P < 0.0001) for WCHT and 3.8 (2.9-5.0, P < 0.0001) for MHT. CONCLUSIONS: Persons with WCHT and MHT have a three to four-fold risk for developing SHT than those with NT and could benefit from active follow-up and lifestyle counselling.