Home Blood Pressure Is a Predictor of Coronary Disease

Study Questions:

What is the relationship between home blood pressure (HBP) and the incidence of coronary artery disease (CAD) events and stroke events?


This was an analysis of data from the HONEST (Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure) study. Olmesartan-naive patients with a physician-reported diagnosis of essential hypertension, and who had recorded their morning HBP on 2 of the 28 days before starting Olmesartan therapy, were eligible to participate. HBP was measured at 1, 4, and 16 weeks, and at 6, 12, 18, and 24 months. Patients measured their HBP twice in the morning and twice at bedtime on 2 different days for each measurement point. Clinic blood pressure (CBP) was measured at 4 and 16 weeks, and at 6, 12, 18, and 24 months. All ischemic and hemorrhagic cerebrovascular events were described as stroke events. Myocardial infarction and angina pectoris with revascularization procedure were defined as CAD events.


Of the 21,591 patients whose data were included in the final analysis, the number of stroke events and CAD events were 127 (2.92/1,000 patient-years) and 121 (2.78/1,000 patient-years), respectively. The hazard ratio (HR) was 6.01 (95% confidence interval [CI], 2.85-12.68) between patients with home systolic blood pressure (HSBP) ≥155 mm Hg and those with morning HSBP <125 mm Hg; morning HSBP predicted stroke events similarly to clinic systolic blood pressure (CSBP). The HR for CAD for morning HSBP ≥155 mm Hg was 6.24 (95% CI, 2.82-13.84) and HR for CSBP ≥160 mm Hg was 3.51 (1.71-7.20). Compared with HSBP, CSBP may underestimate CAD risk.


The authors concluded that HBP is a strong predictor of CAD and stroke events.


This is an important and large study of >20,000 hypertensive Japanese patients. Though the results suggest morning HBP may be superior to CBP as a predictor of CAD events and equivalent in predicting stroke events, randomized controlled trials are necessary to more definitively establish the relationship between morning HBP readings and adverse cardiovascular outcomes.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Hypertension

Keywords: Angina Pectoris, Blood Pressure, Blood Pressure Determination, Coronary Artery Disease, Hypertension, Metabolic Syndrome X, Myocardial Infarction, Primary Prevention, Risk Factors, Stroke, Vascular Diseases

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