30 Mar Morning Home Blood Pressure Is Stronger Predictor of CAD and Stroke

MedicalResearch.com Interview with:

Dr. Kazuomi Kario

Kazuomi Kario, MD, PhD, FACP, FACC, FAHA, FESC
Professor, Chairman
Division of Cardiovascular Medicine, Department of Medicine,
Jichi Medical University School of Medicine (JMU)
JMU Center of Excellence, Cardiovascular Research and Development (JCARD)
Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network
Staff Visiting Professor of Medicine, UCL Institute of Cardiovascular Science
University College London, London UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The relationship between out-of-office blood pressure (BP), such as ambulatory BP and home BP, and cardiovascular events has been investigated in several studies. However, there is insufficient evidence as yet regarding which BP measurement predicts coronary artery disease (CAD) events most strongly.

The HONEST Study is the largest prospective observational study in the world, which enrolled >20,000 hypertensive patients. The study observed cardiovascular events, monitoring both clinic BP and home BP on treatment of antihypertensive agent.

The present analysis shows that home blood pressure measured in morning (morning home BP) is a strong predictor of both CAD and stroke events in future, and may be superior to clinic BP in this regard. Furthermore, there does not appear to be a J-curve in the relationship between morning home  blood pressure and CAD or stroke events.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Few reports have investigated the predictive ability of home  blood pressure for CAD events. This largest home BP prospective study first demonstrated that morning home BP may be superior to clinic BP for the prediction of CAD events. In clinical practice, morning home BP-guided approach of 24-hr management of hypertension will detect the risk of both stroke and CAD, resulting in more effective than office BP- guided management.

In addition, the no J curve between morning home  blood pressure and both CAD and stroke events support the strict BP control. This may partly support the results of SPRINT, and recent metaanalysis published in the Lancet.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The findings of the present study are limited by the study design, which was intended to reflect real-world clinical practice. Therefore, randomized controlled trials are needed to confirm the relationship between morning home blood pressure readings and future ischemic events.

MedicalResearch.com: Is there anything else you would like to add?

Response: Previous analysis of the HONEST study focused on a composite cardiovascular endpoint ¹⁾.

REFERENCE

• Kario K, Saito I, Kushiro T, et al. Home blood pressure and cardiovascular outcomes in patients during antihypertensive therapy: primary results of HONEST, a large-scale prospective, real-world observational study. Hypertension 2014;64:989–96.

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Citation:

Kario K, Saito I, Kushiro T, et al. Morning Home Blood Pressure Is a Strong Predictor of Coronary Artery Disease: The HONEST Study. J Am Coll Cardiol. 2016;67(13):1519-1527. doi:10.1016/j.jacc.2016.01.037.

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Dr. Kazuomi Kario (2016). Morning Home Blood Pressure Is Stronger Predictor of CAD and Stroke MedicalResearch.com

Last Updated on March 30, 2016 by Marie Benz MD FAAD