Home measurement of blood pressure and cardiovascular disease: systematic review and meta-analysis of prospective studies

Objective: Examine the relationship between home blood pressure (BP) and risk for all-cause mortality, cardiovascular mortality and cardiovascular events. Methods: We conducted a systematic review and meta-analysis of prospective studies of home BP. Primary outcomes were all-cause mortality, cardiovascular mortality and cardiovascular events. We extracted hazard ratios and 95% confidence intervals (CIs) which were pooled with a random-effects model. Heterogeneity was assessed using the I2 statistic. Results: We identified eight studies with 17 698 participants. Follow-up was 3.2–10.9 years. For all-cause mortality (n = 747) the hazard ratio for home BP was 1.14 (95% CI 1.01–1.29) per 10 mmHg increase in systolic BP compared to 1.07 (0.91–1.26) for office BP. For cardiovascular mortality (n = 193) the hazard ratio for home BP was 1.29 (1.02–1.64) per 10 mmHg increase in systolic BP compared to 1.15 (0.91–1.46) for office BP. For cardiovascular events (n = 699) the hazard ratio for home BP was 1.14 (1.09–1.20) per 10 mmHg increase in systolic BP compared to 1.10 (1.06–1.15) for office BP. In three studies which adjusted for office and home BP the hazard ratio was 1.20 (1.11–1.30) per 10 mmHg increase in systolic BP for home BP adjusted for office BP compared to 0.99 (0.93–1.07) per 10 mmHg increase in systolic BP for office BP adjusted for home BP. Diastolic results were similar. Conclusions: Home BP remained a significant predictor of cardiovascular mortality and cardiovascular events after adjusting for office BP suggesting it is an important prognostic variable over and above that of office BP.