Am J Hypertens. 2022 Oct 30:hpac121. doi: 10.1093/ajh/hpac121. Online ahead of print.
BACKGROUND: We investigated the association between ambulatory blood pressure (BP) and the risk of home hypertension in a normotensive population and whether considering ambulatory BP improves the 10-year prediction model for home hypertension risk, which was developed in the previous Ohasama Study.
METHODS: In this prospective study, we followed up 410 participants (83.2% women; age, 53.6 years) without home and ambulatory hypertension in the general population of Ohasama, Japan. The Cox model was used to assess the hazard ratios for home hypertension (home BP ≥135/≥85 mmHg or initiation of antihypertensive treatment) and model improvement.
RESULTS: During a mean 14.2-year follow-up, 225 home hypertension incidences occurred. The hazard ratio (95% confidence interval) for home hypertension incidence per 1-standard deviation higher (=6.76 mmHg) 24-h systolic BP was 1.59 (1.33-1.90), after adjustments for possible confounding factors, including baseline home systolic BP. Harrell’s C-statistics increased from 0.72 to 0.73 (P=0.11) when 24-h systolic BP was added to the basic 10-year home hypertension prediction model, which includes sex, age, body mass index, smoking status, office systolic BP, and baseline home systolic BP. Continuous net reclassification improvement (0.53, P<0.0001) and integrated discrimination improvement (0.028, P=0.0014) revealed improvement in the model.
CONCLUSIONS: 24-h systolic BP could be an independent predictor of future home hypertension. Home BP and 24-h BP can longitudinally influence each other in the long term.