OP.1C.07] PROGNOSTIC VALUE OF HOME VERSUS OFFICE BLOOD PRESSURE VARIABILITY

Abstract

Objective: Accumulating evidence suggests that blood pressure variability (BPV) predicts cardiovascular risk independently of the average blood pressure (BP). This study explored the prognostic ability of home versus office BPV. Design and method: In 1997 all adult population of Didima, Argolida, Greece was invited to participate in a study involving office (2 visits, 6 readings) and home (3 days, 12 readings) BP measurements. Cardiovascular morbidity and mortality were assessed after 19.0 ± 1.4 years (2016). Standard deviation (SD) and coefficient of variation (CV) of home and office BP were used to quantify BPV. Results: 665 participants (age 54.4 ± 17.7 years, 42% men) were analyzed. During follow-up 216 deaths (124 cardiovascular) and 146 cardiovascular events (fatal and non-fatal) were documented. In Cox regression models, all indices of systolic home BPV were predictive of cardiovascular risk, even after adjustment for all available cardiovascular risk factors (adjusted HR 1.05 for a 1-SD increase in systolic home BPV and 1.06 for 1% increment in percentage CV; all p < 0.05). The HR for SD (but not CV) of diastolic home BP significantly predicted cardiovascular outcome, yet it lost statistical significance after adjustment for several cardiovascular risk factors (adjusted HR 1.03 for a 1-SD increase in BPV, p = NS). For office BP, only unadjusted indices of BPV were predictive of cardiovascular risk (adjusted HR 1.01/1.03 for a 1-SD increase in systolic/diastolic BPV and 1.02/1.02 for 1% increment in percentage CV; all p = NS). In Cox model including CVs of both home and office systolic BP as independent variables, CV of home BP remained a significant predictor of cardiovascular outcome independent of office BPV.Conclusions: In this long-term general population outcome study, both home and office BPV independently predicted cardiovascular events, with indices of home systolic BPV exhibiting superior prognostic ability.