ASSOCIATION OF AMBULATORY AND HOME BLOOD PRESSURE VARIABILITY FOR CARDIOVASCULAR OUTCOMES

Abstract

Objective: Although blood pressure (BP) variability (BPV) is reportedly associated with cardiovascular prognosis, there is no evidence that either ambulatory BPV (ABPV) or home BPV (HBPV) is a superior clinical marker. Design and method: We analyzed the association of ABPV and HBPV with cardiovascular prognosis in 1,319 hypertensive outpatients who underwent both home and ambulatory BP measurements in the Japan Morning Surge-Home Blood Pressure (J-HOP) study. BPV is evaluated by standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of 24-h ambulatory and average morning and evening home systolic BP. Results: During the median 6.9 years of follow-up, 109 cardiovascular events occurred. All SD, CV, and ARV of HBPV were significantly associated with cardiovascular risk even after adjusted by ABPV (1-SD of HR [95%CI] in SD, CV, and ARV of HBPV: 1.47 [1.23–1.75]; 1.48 [1.24–1.75]; and 1.33 [1.14–1.54]). In the model improvement using goodness-of-fit, HBPV values significantly improved the model predictability when adding to the model including confounding factors and mean 24-h ambulatory SBP and ABPV values. However, these relationships were not shown in ABPV parameters. Conclusions: Based on the findings from this study using both ambulatory and home BP monitoring in the same individuals, HBPV, i.e., day-to-day BPV, was suggested to have superiority in predicting for cardiovascular incidence compared to ABPV, i.e., short-term BPV through 24-hours.