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Different Blood Pressure Measures and LV Mass
Quick Takes
- These data suggest that 1 week of home blood pressure (BP) measurements is more reliable than repeated office or ambulatory BP monitoring and correlates more closely with LV mass and supports its use for the diagnosis of hypertension and its associated risk of cardiovascular disease.
- Additional work is needed to educate patients in the optimum methodology and frequency of home BP monitoring to guide management and improve long-term outcomes in hypertension.
Study Questions:
What is the reliability of office blood pressure (OBP), ambulatory BP (ABP), and home BP (HBP) measurements and their associations with left ventricular mass index (LVMI) in untreated persons?
Methods:
The investigators conducted the Improving the Detection of Hypertension (IDH) study, a community-based observational study, and enrolled 408 participants who had OBP assessed at three visits, and completed 3 weeks of HBP, two 24-hour ABP recordings, and a two-dimensional echocardiogram. Mean age of the cohort was 41.2 ± 13.1 years; 59.5% were women, 25.5% African American, and 64.0% Hispanic. Linear regression was used to estimate the association of office, home, and ambulatory BP with LVMI.
Results:
The reliability of 1 week of HBP, three office visits with mercury sphygmomanometry, and 24-hour ABP were 0.938, 0.894, and 0.846 for systolic and 0.918, 0.847, and 0.843 for diastolic BP, respectively. The correlations among OBP, HBP, and ABP, corrected for regression dilution bias, were 0.74-0.89. After multivariable adjustment including OBP and 24-hour ABP, 10 mm Hg higher systolic and diastolic HBP were associated with 5.07 (standard error [SE], 1.48) and 3.92 (SE, 2.14) g/m2 higher LVMI, respectively. After adjustment for HBP, neither systolic nor diastolic OBP nor ABP was associated with LVMI.
Conclusions:
The authors concluded that compared with OBP (three visits) or 24-hour ABP, systolic and diastolic home BP (1 week) were more reliable and more strongly associated with LVMI.
Perspective:
This cohort study reports that the mean systolic BP from 1 week of HBPM was associated with LVMI after adjustment for office-measured systolic BP and awake, asleep, or 24-hour ambulatory systolic BP. In addition, mean diastolic BP from 1 week of HBPM was associated with LVMI after adjustment for office measured diastolic BP and awake diastolic BP on ABPM. These data suggest that 1 week of HBPM is more reliable than repeated office or ABPM and correlates more closely with LV mass and supports its use for the diagnosis of hypertension and its associated risk of cardiovascular disease. Additional work is needed to educate patients in the optimum methodology and frequency of HBPM to guide management and improve long-term outcomes in hypertension.
Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Echocardiography/Ultrasound, Hypertension
Keywords: Blood Pressure, Blood Pressure Determination, Blood Pressure Monitoring, Ambulatory, Diagnostic Imaging, Diastole, Echocardiography, Heart Failure, Hypertension, Primary Prevention, Sphygmomanometers, Systole, Vascular Diseases
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