Prognostic Value of the Variability in Home-Measured Blood Pressure and Heart Rate: The Finn-Home Study

The objective of the study was to assess the prognostic value of variability in home-measured blood pressure (BP) and heart rate (HR) in a general population. We studied a representative sample of the Finnish adult population with 1866 study subjects aged 45–74 years. BP and HR self-measurements were performed on 7 consecutive days. The variabilities of BP and HR were defined as the SDs of morning minus evening, day-by-day, and first minus second measurements. The primary end point was incidence of a cardiovascular event. The secondary end point was total mortality. During a follow-up of 7.8 years, 179 subjects had experienced a cardiovascular event, and 130 subjects had died. In Cox proportional hazard models adjusted for age, sex, BP/HR, and other cardiovascular risk factors, morning-evening home BP variability (systolic/diastolic relative hazard: 1.04/1.10 [95% CI: 1.01–1.07/1.05–1.15] per 1-mm Hg increase in BP variability) and morning day-by-day home BP variability (relative hazard: 1.04/1.10 [95% CI: 1.00–1.07/1.04–1.16] per 1-mm Hg increase in BP variability) were predictive of cardiovascular events. Morning-evening home HR variability (relative hazard: 1.07 [95% CI: 1.02–1.12] per 1-bpm increase in HR variability) and morning day-by-day home HR variability (relative hazard: 1.11 [95% CI: 1.05–1.17] per 1-bpm increase in HR variability) were also independent predictors of cardiovascular events. Greater variabilities of morning home BP and HR are independent predictors of cardiovascular events. Because the variabilities of home BP and HR are easily acquired in conjunction with home BP and HR level, they should be used as the additive information in the assessment of cardiovascular risk.

[1]  M. Nieminen,et al.  Home-measured blood pressure is more strongly associated with atherosclerosis than clinic blood pressure: the Finn–HOME Study , 2007, Journal of hypertension.

[2]  David Goff,et al.  Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society Of Hypertension, and Preventive Cardiovascular Nurses Association. , 2008, Hypertension.

[3]  S. Heistaro Methodology report : Health 2000 survey , 2008 .

[4]  Yutaka Imai,et al.  How many times should blood pressure be measured at home for better prediction of stroke risk? Ten-year follow-up results from the Ohasama study , 2004, Journal of hypertension.

[5]  Salvador A. Pintos,et al.  A reliable index for the prognostic significance of blood pressure variability , 2005, Journal of hypertension.

[6]  Yutaka Imai,et al.  European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring , 2008, Journal of hypertension.

[7]  David Goff,et al.  Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: A Joint Scientific Statement From the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association , 2008, The Journal of cardiovascular nursing.

[8]  A. Jula,et al.  Multiple clinic and home blood pressure measurements versus ambulatory blood pressure monitoring. , 1999, Hypertension.

[9]  A. Jula,et al.  Home-measured blood pressure is more strongly associated with electrocardiographic left ventricular hypertrophy than is clinic blood pressure: the Finn-HOME study , 2007, Journal of Human Hypertension.

[10]  M. O'Rourke,et al.  Mechanical factors in arterial aging: a clinical perspective. , 2007, Journal of the American College of Cardiology.

[11]  S. Willich,et al.  Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. , 1987, The New England journal of medicine.

[12]  Shigeru Hisamichi,et al.  Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population‐based observation in Ohasama, Japan , 1998, Journal of hypertension.

[13]  G. Atkinson,et al.  Circadian variation in the circulatory responses to exercise: relevance to the morning peaks in strokes and cardiac events , 2009, European Journal of Applied Physiology.

[14]  J. Born,et al.  Plasma epinephrine and norepinephrine concentrations of healthy humans associated with nighttime sleep and morning arousal. , 1997, Hypertension.

[15]  K. Asayama,et al.  Day-by-Day Variability of Blood Pressure and Heart Rate at Home as a Novel Predictor of Prognosis: The Ohasama Study , 2008, Hypertension.

[16]  A. Jula,et al.  Comparison of agreement between clinic and home-measured blood pressure in the Finnish population: the Finn-HOME Study , 2006, Journal of hypertension.

[17]  Yutaka Imai,et al.  Prognostic value of home heart rate for cardiovascular mortality in the general population: the Ohasama study. , 2004, American journal of hypertension.

[18]  O. Hanon,et al.  Validation of two devices for self-measurement of blood pressure by elderly patients according to the revised British Hypertension Society protocol: the Omron HEM-722C and HEM-735C. , 1999, Blood pressure monitoring.

[19]  A. Jula,et al.  Factors affecting the variability of home-measured blood pressure and heart rate: the Finn-home study , 2010, Journal of hypertension.

[20]  P. Nilsson,et al.  The early life origins of vascular ageing and cardiovascular risk: the EVA syndrome , 2008, Journal of hypertension.

[21]  Y. Imai,et al.  Reproducibility of home blood pressure measurements over a 1-year period. , 1997, American journal of hypertension.