Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure
Open accessAbstract
Hypertension guidelines recommend blood pressure self-measurement at home (HBP), but no previous trial has assessed cardiovascular outcomes in hypertensive patients treated according to HBP. The multicenter Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP; 2001-2010) trial involved 3518 patients (50% women; mean age 59.6 years) with an untreated systolic/diastolic HBP of 135-179/85-119 mm Hg. In a 2 × 3 design, patients were randomized to usual control (125-134/80-84 mm Hg (UC)) vs. tight control (<125/<80 mm Hg (TC)) of HBP and to initiation of drug treatment with angiotensin converting enzyme inhibitors, angiotensin receptor blockers or calcium channel blockers. During follow-up, a computer algorithm automatically generated treatment recommendations based on HBP. At the last follow-up (median 5.3 years), TC patients used more antihypertensive drugs than UC patients (1.82 vs. 1.74 defined daily doses, P=0.045) and had a greater HBP reduction (21.3/13.1 mm Hg vs. 22.7/13.9 mm Hg, P=0.018/0.020), but they less frequently achieved the lower HBP targets (37.4 vs. 63.5%, P<0.0001). The primary end point, cardiovascular death plus stroke and myocardial infarction, occurred in 25 UC and 26 TC patients (hazard ratio, 1.02; 95% confidence interval, 0.59-1.77; P=0.94). Rates were similar (P≥0.13) in the three drug groups. In all patients combined, the risk of the primary end point independently increased by 41% (6-89%; P=0.019) and 47% (15-87%; P=0.0020) for a 1-s.d. increase in baseline (12.5 mm Hg) and follow-up (13.2 mm Hg) systolic HBP. The 5-year risk was minimal (≤1%) if on-treatment systolic HBP was 131.6 mm Hg or less. HOMED-BP proved the feasibility of adjusting antihypertensive drug treatment based on HBP and suggests that a systolic HBP level of 130 mm Hg should be an achievable and safe target.
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In another study in primary care setting, when 130/80 mmHg threshold was applied, white-coat hypertension cases exhibited some difference in risk compared with normotensive patients (OR 2.0, 95% CI 0.5-7.7).
“in another study in primary care setting, when 130/80 mmHg threshold was applied, white-coat hypertension cases exhibited some difference in risk compared with normotensive patients (OR 2.0, 95% CI 0.5–7.7) [151]”
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Self-citationBlood pressure targets in adults with hypertension
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Self-citationThe HOPE Asia network 2022 up‐date consensus statement on morning hypertension management
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Morning Home Blood Pressure and Cardiovascular Events in Japanese Hypertensive Patients
Kario, K., Iwashita, M., Okuda, Y., Sugiyama, M., Saito, I., Kushiro, T., Teramukai, S., & Shimada, K. (2018) · Hypertension · doi:10.1161/hypertensionaha.118.11388 · Cited by 46 · see citing works
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Self-citationLifetime Risk of Stroke and Coronary Heart Disease Deaths According to Blood Pressure Level
Satoh, M., Ohkubo, T., Asayama, K., Murakami, Y., Sugiyama, D., Yamada, M., Saitoh, S., Sakata, K., Irie, F., Sairenchi, T., et al. (2018) · Hypertension · doi:10.1161/hypertensionaha.118.11635 · Cited by 42 · see citing works
Self-citationOptimal blood pressure targets for patients with hypertension: a systematic review and meta-analysis
Sakima, A., Satonaka, H., Nishida, N., Yatsu, K., & Arima, H. (2019) · Hypertension Research · doi:10.1038/s41440-018-0123-4 · Cited by 42 · see citing works
Lin, H.-J., Wang, T.-D., Chen, M. Y.-C., Hsu, C.-Y., Wang, K.-L., Huang, C.-C., Hsieh, M.-J., Chiu, Y.-W., Chiang, L., Chuang, W., et al. (2020) · Acta Cardiologica Sinica · doi:10.6515/acs.202011_36(6).20201106a · Cited by 32 · see citing works
Asayama, K., Ohkubo, T., Hanazawa, T., Watabe, D., Hosaka, M., Satoh, M., Yasui, D., Staessen, J. A., Imai, Y., & the Hypertensive Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED‐BP) Study Investigators (2016) · Journal of the American Heart Association · doi:10.1161/jaha.115.002995 · Cited by 35 · see citing works
Self-citationPerfect 24-h management of hypertension: clinical relevance and perspectives
Kario, K. (2016) · Journal of Human Hypertension · doi:10.1038/jhh.2016.65 · Cited by 34 · see citing works
Kario, K. (2015) · Pulse · doi:10.1159/000381300 · Cited by 32 · see citing works
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The Japanese Society of Hypertension Working Group on the COmparison of Self-measured home, A. U. O. A. C. A. O. B. P. (. S., Asayama, K., Ohkubo, T., Rakugi, H., Miyakawa, M., Mori, H., Katsuya, T., Ikehara, Y., Ueda, S., Ohya, Y., et al. (2019) · Hypertension Research · doi:10.1038/s41440-019-0287-6 · Cited by 33 · see citing works
Self-citationThe current state and future of internet technology-based hypertension management in Japan
Yatabe, J., Yatabe, M., & Ichihara, A. (2020) · Hypertension Research · doi:10.1038/s41440-020-00591-0 · Cited by 31 · see citing works
Satoh, M., Muroya, T., Murakami, T., Obara, T., Asayama, K., Ohkubo, T., Imai, Y., & Metoki, H. (2023) · Hypertension Research · doi:10.1038/s41440-023-01452-2 · Cited by 29 · see citing works
Self-citationIn-office and out-of-office blood pressure measurement
Asayama, K., Ohkubo, T., & Imai, Y. (2021) · Journal of Human Hypertension · doi:10.1038/s41371-021-00486-8 · Cited by 32 · see citing works
Self-citationSatoh, M., Maeda, T., Hoshide, S., & Ohkubo, T. (2019) · Hypertension Research · doi:10.1038/s41440-019-0221-y · Cited by 28 · see citing works
Self-citationRationale, study design, baseline characteristics and blood pressure at 16 weeks in the HONEST Study
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Diurnal blood pressure changes
Asayama, K., Satoh, M., & Kikuya, M. (2018) · Hypertension Research · doi:10.1038/s41440-018-0054-0 · Cited by 27 · see citing works
Self-citationIhm, S., Park, J., Kim, J., Kim, J. H., Kim, K., Lee, E. M., Lee, H.-Y., Park, S., Shin, J.-H., & Kim, C. (2022) · Clinical Hypertension · doi:10.1186/s40885-022-00218-1 · Cited by 31 · see citing works
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Calcium channel blockers versus other classes of drugs for hypertension
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Asayama, K., Stolarz‐Skrzypek, K., Yang, W., Hansen, T. W., Brguljan-Hitij, J., Odili, A. N., Li, Y., & Staessen, J. A. (2023) · Hypertension Research · doi:10.1038/s41440-023-01191-4 · Cited by 22 · see citing works
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Asayama, K., Wei, F., Liu, Y.-P., Hara, A., Gu, Y.-M., Schutte, R., Li, Y., Thijs, L., & Staessen, J. A. (2014) · Hypertension Research · doi:10.1038/hr.2014.153 · Cited by 20 · see citing works
Self-citationImai, Y., Hosaka, M., Elnagar, N., & Satoh, M. (2013) · Clinical and Experimental Pharmacology and Physiology · doi:10.1111/1440-1681.12142 · Cited by 20 · see citing works
Self-citationHaze, T., Katsurada, K., Sakata, S., Kuwabara, M., Nishida, N., Azegami, T., Sakima, A., & Kai, H. (2025) · Hypertension Research · doi:10.1038/s41440-025-02131-0 · Cited by 19 · see citing works
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The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020
Kario, K. (2020) · Journal of Clinical Hypertension · doi:10.1111/jch.13750 · Cited by 18 · see citing works
Satoh, M., Maeda, T., Hoshide, S., & Ohkubo, T. (2019) · Hypertension Research · doi:10.1038/s41440-019-0280-0 · Cited by 19 · see citing works
Self-citationDetermining the Optimal Systolic Blood Pressure for Hypertensive Patients: A Network Meta-analysis
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Cost-Effectiveness of Noninvasive Central Blood Pressure Monitoring in the Diagnosis of Hypertension
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The lowest well tolerated blood pressure: A personalized target for all?
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The HOPE Asia Network for “zero” cardiovascular events in Asia
Kario, K., & the HOPE Asia (Hypertension Cardiovascular Outcome Prevention and Evidence in Asia) Network (2018) · Journal of Clinical Hypertension · doi:10.1111/jch.13185 · Cited by 15 · see citing works
Aschmann, H. E., Boyd, C. M., Robbins, C. W., Mularski, R. A., Chan, W., Sheehan, O. C., Wilson, R. F., Bennett, W. L., Bayliss, E. A., Yu, T., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-028438 · Cited by 15 · see citing works
Yatabe, M., Yatabe, J., Asayama, K., Staessen, J. A., Mujaj, B., Thijs, L., Ito, K., Sonoo, T., Morimoto, S., & Ichihara, A. (2017) · Blood Pressure · doi:10.1080/08037051.2017.1406306 · Cited by 16 · see citing works
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The JSH Morning Hypertension Eradication Program Project
Kario, K., Nishiyama, A., Shibata, S., Mogi, M., Arima, H., Kishi, T., Ishida, M., Furuhashi, M., Ichihara, A., Katsuya, T., et al. (2025) · Hypertension Research · doi:10.1038/s41440-025-02330-9 · Cited by 14 · see citing works
Self-citationPractical Use of Home Blood Pressure Monitoring in Chronic Kidney Disease
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Thijs, L., Asayama, K., Maestre, G. E., Hansen, T. W., Buyse, L., Wei, D., Melgarejo, J. D., Brguljan-Hitij, J., Cheng, H., de Souza, F., et al. (2021) · Blood Pressure · doi:10.1080/08037051.2021.1952061 · Cited by 14 · see citing works
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Standardized home blood pressure monitoring: Rationale behind the 722 protocol
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Self-citationPerspectives of renal denervation from hypertension to heart failure in Asia
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Self-citationInsights on home blood pressure monitoring in Asia: Expert perspectives from 10 countries/regions
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- Authors
- on behalf of Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP) investigators, Asayama, K., Ohkubo, T., Metoki, H., Obara, T., Inoue, R., Kikuya, M., Thijs, L., Staessen, J. A., & Imai, Y.
- Affiliations
- Tohoku University (JP)
- Shiga University of Medical Science (JP)
- Maastricht University (NL)
- Corresponding author
- Imai, Yutaka
- ORCID
- Venue
- Hypertension Research
- Published
- 2012-08-16
- Volume
- 35
- Issue
- 11
- Pages
- 1102-1110
- ISSN
- 0916-9636 (ISSN-L)
- 1348-4214
- OpenAlex
- W2020243407
- Cited by
- 186
- References
- 47
- Citations by year
- 2026: 12 · 2025: 16 · 2024: 8 · 2023: 6 · 2022: 16 · 2021: 17 · 2020: 11 · 2019: 19 · 2018: 20 · 2017: 16 · 2016: 16 · 2015: 10 · 2014: 7 · 2013: 8 · 2012: 4
- FWCI
- 5.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Hypertension Research (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by-nc-nd)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- Japan Cardiovascular Research Foundation
- Omron Healthcare
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- hypertension, self-measured blood pressure, antihypertensive therapy, cardiovascular outcomes, cardiovascular mortality, stroke, myocardial infarction, tight blood pressure control, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, systolic blood pressure, primary prevention, secondary prevention, cardiovascular risk prediction, antihypertensive medication use
- MeSH terms
- Algorithms, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Blood Pressure, Calcium Channel Blockers, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Hypertension, Male, Middle Aged, Prospective Studies, Risk Factors, Treatment Outcome, Blood Pressure Monitoring, Ambulatory, Angiotensin II Type 1 Receptor Blockers
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