Proposal of Reference Values for Home Blood Pressure Measurement: Prognostic Criteria Based on a Prospective Observation of the General Population in Ohasama,Japan |
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| Institution: | 1. Department of Public Health, Tohoku University School of Medicine, Sendai, Japan;2. Department of Medicine, Tohoku University School of Medicine, Sendai, Japan;3. Department of Environmental Health Science, Tohoku University School of Medicine, Sendai, Japan;4. Department of Medicine, Ohasama Hospital, Iwate, Japan;1. Kaiser Permanente Northern California Division of Research, Oakland, CA, United States;2. Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States;3. University of Washington Department of Obstetrics and Gynecology, Seattle, WA, United States;4. Chapman University School of Pharmacy, Irvine, CA, United States;5. University of Washington Department of Epidemiology, Seattle, WA, United States;1. Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran;2. Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran;3. Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran;4. Interventional electrophysiologist, Tehran Arrhythmia Clinic, Tehran, Iran;1. Oxford Menopause Ltd, Oxfordshire, UK;2. Community Gynaecology, Oxfordshire, UK;1. Service de Gynécologie-Obstétrique, CHU Toulouse Hôpital Paule de Viguier, Toulouse, France;2. INSERM UMR1027, Université Toulouse III, Toulouse, France;3. Service de Gynécologie-Obstétrique, CHU Angers, Angers, France;4. Université Grenoble Alpes, TIMC-IMAG, Grenoble, France;5. CNRS, TIMC-IMAG, Grenoble, France;6. CHU Grenoble, Pôle Santé Publique, Grenoble, France;7. Collectif Interassociatif Autour de la Naissance, Paris, France;8. Cabinet médical, Lyon, France;9. Service de réanimation et médecine néonatales, hôpital mère-enfant, CHU de Nantes, Nantes, France;10. Service de réanimation et médecine néonatales, pôle femme-mère-enfant, CHU d’Angers, Angers, France;11. Département de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France;12. Maternité Port-Royal, groupe hospitalier Cochin – hôtel-Dieu, Paris, France;13. Clinique d’obstétrique, pôle femme – mère-nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France;14. Cytogénétique, hôpital universitaire Necker-Enfants-Malades, Paris, France;15. Service d’anatomie pathologique, pôle biologie pathologie, hôpital Morvan, CHRU de Brest, Brest, France;p. Service de gynécologie obstétrique, CHU Pitié-Salpêtrière, Paris, France;q. Pôle de gynécologie obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe de Gouges, CHRU de Tours, Tours, France;r. Maternité, hôpital universitaire Necker-Enfants-Malades, Paris, France;s. Service de gynécologie-obstétrique, hôpital Bicêtre, Le Kremlin-Bicêtre, France;t. Service de réanimation néonatale, hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France;u. Unité d’obstétrique – maternité, hôpital Trousseau, Assistance Publique – Hôpitaux de Paris, université Pierre-et-Marie-Curie-Paris 6, France |
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| Abstract: | The purpose of this study was to propose reference values, from a viewpoint of prognostic significance, for blood pressure (BP) measured at home with a semiautomated device (home BP measurement) to differentiate normotension and hypertension. We obtained home BP measurements for 1,913 population-based subjects aged 40 years and over in a rural Japanese community and followed up their survival for a mean duration of 5.0 years. There were 141 deaths during the follow-up period. The association between baseline BP values and the overall mortality was examined by Cox proportional hazards regression model, adjusted for age, gender, and the use of antihypertensive medication. The results indicated that the predictive power of home BP level for subsequent mortality was stronger than that of casual screening BP. There was a linear association between home systolic BP and mortality. The association between home diastolic BP and mortality was nonlinear and well approximated with the secondary degree equation of diastolic BP values. Based on this relation, we propose that the reference value for hypertension is 137/84 mm Hg, and normotension is below 137 mm Hg for home systolic BP and between 66 and 83 mm Hg for home diastolic BP. Home diastolic BP below 66 mm Hg should be considered as low diastolic blood pressure. In this population, home systolic BP of 137 mm Hg and home diastolic BP of 84 mm Hg corresponded to the 80th and 87th percentiles, respectively. Then, 29% of the subjects were classified as having hypertension, 52% as normotension, and 19% as low diastolic blood pressure. All previous studies proposing reference values for home BP measurement, derived from cross-sectional observations, were based on the statistical distribution of home BP values. The reference value must, however, be the one that best predicts the risk for morbidity and mortality from hypertension-related complications. This is the first report proposing reference values for home BP measurement based on prognostic criteria. |
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