Predictive power of home blood pressure and clinic blood pressure in hypertensive patients with impaired glucose metabolism and diabetes

Yuichi Noguchi*, Kei Asayama, Jan A. Staessen, Munemichi Inaba, Takayoshi Ohkubo, Miki Hosaka, Michihiro Satoh, Kei Kamide, Takuya Awata, Shigehiro Katayama, Yutaka Imai

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

33 Citations (Web of Science)

Abstract

Objectives:We evaluated the predictive power of home blood pressure and clinic blood pressure based on the long-term cardiovascular outcome in hypertensive patients with and without impaired glucose metabolism (IGM).Method:The multicentre Hypertension Objective Treatment Based on Measurement by Electrical Devices Blood Pressure trial (HOMED-BP) involved 3080 patients (50.5% women; mean age 59.7 years) with a baseline, untreated home/clinic blood pressure as well as follow-up, on-treatment blood pressure. Of those, 979 had IGM and 475 of these patients had diabetes. We applied Cox regression pooling all participants in a cohort analysis in which IGM and normal glucose metabolism (NGM) were separated.Results:During median 5.45 years follow-up, cardiovascular events occurred in 48 patients with IGM and 53 patients with NGM. Baseline home SBP significantly predicted cardiovascular outcome among IGM group [hazard ratio 1.68, 95% CI 1.26-2.26, P=0.0005]. On-treatment home blood pressure was a significant predictor for cardiovascular risk even after the further adjustment of baseline blood pressure level (P0.027), whereas on-treatment clinic blood pressure was not in NGM group (P0.37). The event rate in IGM was approximately two times higher than that in NGM (9.95 vs. 4.88 per 1000 patient-years), resulted to the low 5-year number needed to treat in IGM patients [83 vs. 121 for 1-SD (13.1mmHg) home SBP reduction, and 62 vs. 104 for 1-SD (9.5mmHg) home DBP reduction).Conclusion:The present findings suggest that long-term cardiovascular risk in IGM patients should be assessed based on home blood pressure, not on clinic blood pressure.
Original languageEnglish
Pages (from-to)1593-1602
JournalJournal of Hypertension
Volume31
Issue number8
DOIs
Publication statusPublished - Aug 2013

Keywords

  • antihypertensive drug treatment
  • blood pressure assessment and control
  • home blood pressure
  • impaired glucose metabolism

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