Increase Trend in Home Blood Pressure on a Single Occasion Is Associated With B-Type Natriuretic Peptide and the Estimated Glomerular Filtration Rate.

Abstract

Although obtaining multiple home blood pressure (HBP) measurements on a single occasion was recommended in European and Japanese hypertension guidelines, the clinical implications of the differences in BP measurements on a single occasion have been uncertain. Here, 4,149 patients with cardiovascular risk factors were enrolled. We asked the patients to measure their HBP 3 times on a single occasion each day over a 2-week period. We evaluated the target organ damage (TOD) indicators left ventricular mass index (LVMI), urinary albumin creatinine ratio, B-type natriuretic peptide (BNP), N-terminal pro-BNP (NT-pro BNP), high-sensitive cardiac troponin, brachial-ankle pulse wave velocity (ba PWV), intima-media thickness, and estimated glomerular filtration rate (eGFR). The associations between TOD and the difference between the first home systolic BP (SBP) value and the average of the second and third home SBP values were assessed by multiple regression analyses with adjustment for covariates. Compared to the quintile median, the TOD of the first-quintile patients (i.e., those with elevated the second and third home SBP values compared to the first value) were significantly higher BNP, higher NT-pro BNP, higher ba PWV, and lower eGFR. In a univariate analysis of variance, compared to the median quintile, the first-quintile patients had independently and significantly higher BNP, higher NT-pro BNP, and lower eGFR. The patients with elevated the second and third home SBP values compared to the first value taken on a single occasion were likely to have deteriorated BNP, NT-pro BNP, and eGFR.