Home Blood Pressure as a Cardiovascular Outcome Predictor: It’s Time to Take This Method Seriously

Abstract

T he common phenomena of white-coat and masked hypertension have established the need for assessing blood pressure (BP) out of the office, particularly using 24-hour ambulatory monitoring (ABPM).In the last 2 decades, evidence on the usefulness of the alternative method for out-of-office BP assessment, namely home BP monitoring (HBPM), has accumulated, and guidelines on using this method have recently been published in the United States and Europe. 1,2As with ABPM, HBPM allows the detection of white-coat and masked hypertension and has additional advantages, such as wide availability, low cost, and excellent acceptability by hypertensive patients for repeated use. 1,2n this issue of Hypertension, Niiranen et al present the results of Finn-Home, an outcome study of HBPM in the general population in Finland. 3 Strengths of this study are the large data set (Ͼ14,000 subject-years, with 162 documented cardiovascular events) and the use of optimal methodology for office BP measurement (nurses using mercury sphygmomanometers) and HBPM (validated electronic device and guidelinesrecommended monitoring schedule with 7-day duplicate morning and evening measurements).This study contributes to the HBPM and outcome database that now comprises 8 large long-term prospective studies 3-10 including 17,688 subjects and almost 100,000 person-years of follow-up (Table ).There are important differences among these studies regarding the study population, the BP measurements, the definition of primary outcomes, and the methods of statistical adjustment.Studies have been performed in Europe and Japan. Office BP was measured using conventional mercury sphygmomanometers, apart from the Ohasama study, 4 which used electronic devices; and that of Okumiya et al, 5 which did not report