Risk Stratification by Self-Measured Home Blood Pressure across Categories of Conventional Blood Pressure: A Participant-Level Meta-Analysis

Kei Asayama, Lutgarde Thijs, Jana Brguljan-Hitij, Teemu J. Niiranen, Atsushi Hozawa, José Boggia, Lucas S. Aparicio, Azusa Hara, Jouni K. Johansson, Takayoshi Ohkubo, Christophe Tzourio, George S. Stergiou, Edgardo Sandoya, Ichiro Tsuji, Antti M. Jula, Yutaka Imai, Jan A. Staessen, K. Asayama, T. Ohkubo, M. KikuyaR. Inoue, M. Satoh, M. Hosaka, M. T. Utsugi, T. Hirose, A. Hara, N. Fukushima, T. Obara, H. Metoki, Y. Imai, J. Johansson, A. Reunanen, A. Jula, K. Ohmori-Matsuda, S. Kuriyama, M. Kakizaki, A. Hozawa, I. Tsuji, T. Mountokalakis, A. Kollias, G. Thomopoulou, P. Kalogeropoulos, I. Skeva, E. Nasothimiou, N. Pantazis, N. Baibas, J. Boggia, E. Sandoya, J. A. Staessen, L. Thijs, N. Cauwenberghs, Z. Zhang, F. Wei, J. Knez, A. Odili, Y. Gu, Y. Liu, Y. Jin, L. Jacobs, T. Kuznetzova

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background:The Global Burden of Diseases Study 2010 reported that hypertension is worldwide the leading risk factor for cardiovascular disease, causing 9.4 million deaths annually. We examined to what extent self-measurement of home blood pressure (HBP) refines risk stratification across increasing categories of conventional blood pressure (CBP).Methods and Findings:This meta-analysis included 5,008 individuals randomly recruited from five populations (56.6% women; mean age, 57.1 y). All were not treated with antihypertensive drugs. In multivariable analyses, hazard ratios (HRs) associated with 10-mm Hg increases in systolic HBP were computed across CBP categories, using the following systolic/diastolic CBP thresholds (in mm Hg): optimal, <120/<80; normal, 120-129/80-84; high-normal, 130-139/85-89; mild hypertension, 140-159/90-99; and severe hypertension, ≥160/≥100.Over 8.3 y, 522 participants died, and 414, 225, and 194 had cardiovascular, cardiac, and cerebrovascular events, respectively. In participants with optimal or normal CBP, HRs for a composite cardiovascular end point associated with a 10-mm Hg higher systolic HBP were 1.28 (1.01-1.62) and 1.22 (1.00-1.49), respectively. At high-normal CBP and in mild hypertension, the HRs were 1.24 (1.03-1.49) and 1.20 (1.06-1.37), respectively, for all cardiovascular events and 1.33 (1.07-1.65) and 1.30 (1.09-1.56), respectively, for stroke. In severe hypertension, the HRs were not significant (p≥0.20). Among people with optimal, normal, and high-normal CBP, 67 (5.0%), 187 (18.4%), and 315 (30.3%), respectively, had masked hypertension (HBP≥130 mm Hg systolic or ≥85 mm Hg diastolic). Compared to true optimal CBP, masked hypertension was associated with a 2.3-fold (1.5-3.5) higher cardiovascular risk. A limitation was few data from low- and middle-income countries.Conclusions:HBP substantially refines risk stratification at CBP levels assumed to carry no or only mildly increased risk, in particular in the presence of masked hypertension. Randomized trials could help determine the best use of CBP vs. HBP in guiding BP management. Our study identified a novel indication for HBP, which, in view of its low cost and the increased availability of electronic communication, might be globally applicable, even in remote areas or in low-resource settings.Please see later in the article for the Editors' Summary.

Original languageEnglish
Article numbere1001591
JournalPLoS Medicine
Volume11
Issue number1
DOIs
Publication statusPublished - 01-01-2014

Fingerprint

Meta-Analysis
Blood Pressure
Masked Hypertension
Hypertension
Antihypertensive Agents
Cardiovascular Diseases
Stroke

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Asayama, K., Thijs, L., Brguljan-Hitij, J., Niiranen, T. J., Hozawa, A., Boggia, J., ... Kuznetzova, T. (2014). Risk Stratification by Self-Measured Home Blood Pressure across Categories of Conventional Blood Pressure: A Participant-Level Meta-Analysis. PLoS Medicine, 11(1), [e1001591]. https://doi.org/10.1371/journal.pmed.1001591
Asayama, Kei ; Thijs, Lutgarde ; Brguljan-Hitij, Jana ; Niiranen, Teemu J. ; Hozawa, Atsushi ; Boggia, José ; Aparicio, Lucas S. ; Hara, Azusa ; Johansson, Jouni K. ; Ohkubo, Takayoshi ; Tzourio, Christophe ; Stergiou, George S. ; Sandoya, Edgardo ; Tsuji, Ichiro ; Jula, Antti M. ; Imai, Yutaka ; Staessen, Jan A. ; Asayama, K. ; Ohkubo, T. ; Kikuya, M. ; Inoue, R. ; Satoh, M. ; Hosaka, M. ; Utsugi, M. T. ; Hirose, T. ; Hara, A. ; Fukushima, N. ; Obara, T. ; Metoki, H. ; Imai, Y. ; Johansson, J. ; Reunanen, A. ; Jula, A. ; Ohmori-Matsuda, K. ; Kuriyama, S. ; Kakizaki, M. ; Hozawa, A. ; Tsuji, I. ; Mountokalakis, T. ; Kollias, A. ; Thomopoulou, G. ; Kalogeropoulos, P. ; Skeva, I. ; Nasothimiou, E. ; Pantazis, N. ; Baibas, N. ; Boggia, J. ; Sandoya, E. ; Staessen, J. A. ; Thijs, L. ; Cauwenberghs, N. ; Zhang, Z. ; Wei, F. ; Knez, J. ; Odili, A. ; Gu, Y. ; Liu, Y. ; Jin, Y. ; Jacobs, L. ; Kuznetzova, T. / Risk Stratification by Self-Measured Home Blood Pressure across Categories of Conventional Blood Pressure : A Participant-Level Meta-Analysis. In: PLoS Medicine. 2014 ; Vol. 11, No. 1.
@article{ed22788dc417492783217a5f7d3b9155,
title = "Risk Stratification by Self-Measured Home Blood Pressure across Categories of Conventional Blood Pressure: A Participant-Level Meta-Analysis",
abstract = "Background:The Global Burden of Diseases Study 2010 reported that hypertension is worldwide the leading risk factor for cardiovascular disease, causing 9.4 million deaths annually. We examined to what extent self-measurement of home blood pressure (HBP) refines risk stratification across increasing categories of conventional blood pressure (CBP).Methods and Findings:This meta-analysis included 5,008 individuals randomly recruited from five populations (56.6{\%} women; mean age, 57.1 y). All were not treated with antihypertensive drugs. In multivariable analyses, hazard ratios (HRs) associated with 10-mm Hg increases in systolic HBP were computed across CBP categories, using the following systolic/diastolic CBP thresholds (in mm Hg): optimal, <120/<80; normal, 120-129/80-84; high-normal, 130-139/85-89; mild hypertension, 140-159/90-99; and severe hypertension, ≥160/≥100.Over 8.3 y, 522 participants died, and 414, 225, and 194 had cardiovascular, cardiac, and cerebrovascular events, respectively. In participants with optimal or normal CBP, HRs for a composite cardiovascular end point associated with a 10-mm Hg higher systolic HBP were 1.28 (1.01-1.62) and 1.22 (1.00-1.49), respectively. At high-normal CBP and in mild hypertension, the HRs were 1.24 (1.03-1.49) and 1.20 (1.06-1.37), respectively, for all cardiovascular events and 1.33 (1.07-1.65) and 1.30 (1.09-1.56), respectively, for stroke. In severe hypertension, the HRs were not significant (p≥0.20). Among people with optimal, normal, and high-normal CBP, 67 (5.0{\%}), 187 (18.4{\%}), and 315 (30.3{\%}), respectively, had masked hypertension (HBP≥130 mm Hg systolic or ≥85 mm Hg diastolic). Compared to true optimal CBP, masked hypertension was associated with a 2.3-fold (1.5-3.5) higher cardiovascular risk. A limitation was few data from low- and middle-income countries.Conclusions:HBP substantially refines risk stratification at CBP levels assumed to carry no or only mildly increased risk, in particular in the presence of masked hypertension. Randomized trials could help determine the best use of CBP vs. HBP in guiding BP management. Our study identified a novel indication for HBP, which, in view of its low cost and the increased availability of electronic communication, might be globally applicable, even in remote areas or in low-resource settings.Please see later in the article for the Editors' Summary.",
author = "Kei Asayama and Lutgarde Thijs and Jana Brguljan-Hitij and Niiranen, {Teemu J.} and Atsushi Hozawa and Jos{\'e} Boggia and Aparicio, {Lucas S.} and Azusa Hara and Johansson, {Jouni K.} and Takayoshi Ohkubo and Christophe Tzourio and Stergiou, {George S.} and Edgardo Sandoya and Ichiro Tsuji and Jula, {Antti M.} and Yutaka Imai and Staessen, {Jan A.} and K. Asayama and T. Ohkubo and M. Kikuya and R. Inoue and M. Satoh and M. Hosaka and Utsugi, {M. T.} and T. Hirose and A. Hara and N. Fukushima and T. Obara and H. Metoki and Y. Imai and J. Johansson and A. Reunanen and A. Jula and K. Ohmori-Matsuda and S. Kuriyama and M. Kakizaki and A. Hozawa and I. Tsuji and T. Mountokalakis and A. Kollias and G. Thomopoulou and P. Kalogeropoulos and I. Skeva and E. Nasothimiou and N. Pantazis and N. Baibas and J. Boggia and E. Sandoya and Staessen, {J. A.} and L. Thijs and N. Cauwenberghs and Z. Zhang and F. Wei and J. Knez and A. Odili and Y. Gu and Y. Liu and Y. Jin and L. Jacobs and T. Kuznetzova",
year = "2014",
month = "1",
day = "1",
doi = "10.1371/journal.pmed.1001591",
language = "English",
volume = "11",
journal = "PLoS Medicine",
issn = "1549-1277",
publisher = "Public Library of Science",
number = "1",

}

Asayama, K, Thijs, L, Brguljan-Hitij, J, Niiranen, TJ, Hozawa, A, Boggia, J, Aparicio, LS, Hara, A, Johansson, JK, Ohkubo, T, Tzourio, C, Stergiou, GS, Sandoya, E, Tsuji, I, Jula, AM, Imai, Y, Staessen, JA, Asayama, K, Ohkubo, T, Kikuya, M, Inoue, R, Satoh, M, Hosaka, M, Utsugi, MT, Hirose, T, Hara, A, Fukushima, N, Obara, T, Metoki, H, Imai, Y, Johansson, J, Reunanen, A, Jula, A, Ohmori-Matsuda, K, Kuriyama, S, Kakizaki, M, Hozawa, A, Tsuji, I, Mountokalakis, T, Kollias, A, Thomopoulou, G, Kalogeropoulos, P, Skeva, I, Nasothimiou, E, Pantazis, N, Baibas, N, Boggia, J, Sandoya, E, Staessen, JA, Thijs, L, Cauwenberghs, N, Zhang, Z, Wei, F, Knez, J, Odili, A, Gu, Y, Liu, Y, Jin, Y, Jacobs, L & Kuznetzova, T 2014, 'Risk Stratification by Self-Measured Home Blood Pressure across Categories of Conventional Blood Pressure: A Participant-Level Meta-Analysis', PLoS Medicine, vol. 11, no. 1, e1001591. https://doi.org/10.1371/journal.pmed.1001591

Risk Stratification by Self-Measured Home Blood Pressure across Categories of Conventional Blood Pressure : A Participant-Level Meta-Analysis. / Asayama, Kei; Thijs, Lutgarde; Brguljan-Hitij, Jana; Niiranen, Teemu J.; Hozawa, Atsushi; Boggia, José; Aparicio, Lucas S.; Hara, Azusa; Johansson, Jouni K.; Ohkubo, Takayoshi; Tzourio, Christophe; Stergiou, George S.; Sandoya, Edgardo; Tsuji, Ichiro; Jula, Antti M.; Imai, Yutaka; Staessen, Jan A.; Asayama, K.; Ohkubo, T.; Kikuya, M.; Inoue, R.; Satoh, M.; Hosaka, M.; Utsugi, M. T.; Hirose, T.; Hara, A.; Fukushima, N.; Obara, T.; Metoki, H.; Imai, Y.; Johansson, J.; Reunanen, A.; Jula, A.; Ohmori-Matsuda, K.; Kuriyama, S.; Kakizaki, M.; Hozawa, A.; Tsuji, I.; Mountokalakis, T.; Kollias, A.; Thomopoulou, G.; Kalogeropoulos, P.; Skeva, I.; Nasothimiou, E.; Pantazis, N.; Baibas, N.; Boggia, J.; Sandoya, E.; Staessen, J. A.; Thijs, L.; Cauwenberghs, N.; Zhang, Z.; Wei, F.; Knez, J.; Odili, A.; Gu, Y.; Liu, Y.; Jin, Y.; Jacobs, L.; Kuznetzova, T.

In: PLoS Medicine, Vol. 11, No. 1, e1001591, 01.01.2014.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk Stratification by Self-Measured Home Blood Pressure across Categories of Conventional Blood Pressure

T2 - A Participant-Level Meta-Analysis

AU - Asayama, Kei

AU - Thijs, Lutgarde

AU - Brguljan-Hitij, Jana

AU - Niiranen, Teemu J.

AU - Hozawa, Atsushi

AU - Boggia, José

AU - Aparicio, Lucas S.

AU - Hara, Azusa

AU - Johansson, Jouni K.

AU - Ohkubo, Takayoshi

AU - Tzourio, Christophe

AU - Stergiou, George S.

AU - Sandoya, Edgardo

AU - Tsuji, Ichiro

AU - Jula, Antti M.

AU - Imai, Yutaka

AU - Staessen, Jan A.

AU - Asayama, K.

AU - Ohkubo, T.

AU - Kikuya, M.

AU - Inoue, R.

AU - Satoh, M.

AU - Hosaka, M.

AU - Utsugi, M. T.

AU - Hirose, T.

AU - Hara, A.

AU - Fukushima, N.

AU - Obara, T.

AU - Metoki, H.

AU - Imai, Y.

AU - Johansson, J.

AU - Reunanen, A.

AU - Jula, A.

AU - Ohmori-Matsuda, K.

AU - Kuriyama, S.

AU - Kakizaki, M.

AU - Hozawa, A.

AU - Tsuji, I.

AU - Mountokalakis, T.

AU - Kollias, A.

AU - Thomopoulou, G.

AU - Kalogeropoulos, P.

AU - Skeva, I.

AU - Nasothimiou, E.

AU - Pantazis, N.

AU - Baibas, N.

AU - Boggia, J.

AU - Sandoya, E.

AU - Staessen, J. A.

AU - Thijs, L.

AU - Cauwenberghs, N.

AU - Zhang, Z.

AU - Wei, F.

AU - Knez, J.

AU - Odili, A.

AU - Gu, Y.

AU - Liu, Y.

AU - Jin, Y.

AU - Jacobs, L.

AU - Kuznetzova, T.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background:The Global Burden of Diseases Study 2010 reported that hypertension is worldwide the leading risk factor for cardiovascular disease, causing 9.4 million deaths annually. We examined to what extent self-measurement of home blood pressure (HBP) refines risk stratification across increasing categories of conventional blood pressure (CBP).Methods and Findings:This meta-analysis included 5,008 individuals randomly recruited from five populations (56.6% women; mean age, 57.1 y). All were not treated with antihypertensive drugs. In multivariable analyses, hazard ratios (HRs) associated with 10-mm Hg increases in systolic HBP were computed across CBP categories, using the following systolic/diastolic CBP thresholds (in mm Hg): optimal, <120/<80; normal, 120-129/80-84; high-normal, 130-139/85-89; mild hypertension, 140-159/90-99; and severe hypertension, ≥160/≥100.Over 8.3 y, 522 participants died, and 414, 225, and 194 had cardiovascular, cardiac, and cerebrovascular events, respectively. In participants with optimal or normal CBP, HRs for a composite cardiovascular end point associated with a 10-mm Hg higher systolic HBP were 1.28 (1.01-1.62) and 1.22 (1.00-1.49), respectively. At high-normal CBP and in mild hypertension, the HRs were 1.24 (1.03-1.49) and 1.20 (1.06-1.37), respectively, for all cardiovascular events and 1.33 (1.07-1.65) and 1.30 (1.09-1.56), respectively, for stroke. In severe hypertension, the HRs were not significant (p≥0.20). Among people with optimal, normal, and high-normal CBP, 67 (5.0%), 187 (18.4%), and 315 (30.3%), respectively, had masked hypertension (HBP≥130 mm Hg systolic or ≥85 mm Hg diastolic). Compared to true optimal CBP, masked hypertension was associated with a 2.3-fold (1.5-3.5) higher cardiovascular risk. A limitation was few data from low- and middle-income countries.Conclusions:HBP substantially refines risk stratification at CBP levels assumed to carry no or only mildly increased risk, in particular in the presence of masked hypertension. Randomized trials could help determine the best use of CBP vs. HBP in guiding BP management. Our study identified a novel indication for HBP, which, in view of its low cost and the increased availability of electronic communication, might be globally applicable, even in remote areas or in low-resource settings.Please see later in the article for the Editors' Summary.

AB - Background:The Global Burden of Diseases Study 2010 reported that hypertension is worldwide the leading risk factor for cardiovascular disease, causing 9.4 million deaths annually. We examined to what extent self-measurement of home blood pressure (HBP) refines risk stratification across increasing categories of conventional blood pressure (CBP).Methods and Findings:This meta-analysis included 5,008 individuals randomly recruited from five populations (56.6% women; mean age, 57.1 y). All were not treated with antihypertensive drugs. In multivariable analyses, hazard ratios (HRs) associated with 10-mm Hg increases in systolic HBP were computed across CBP categories, using the following systolic/diastolic CBP thresholds (in mm Hg): optimal, <120/<80; normal, 120-129/80-84; high-normal, 130-139/85-89; mild hypertension, 140-159/90-99; and severe hypertension, ≥160/≥100.Over 8.3 y, 522 participants died, and 414, 225, and 194 had cardiovascular, cardiac, and cerebrovascular events, respectively. In participants with optimal or normal CBP, HRs for a composite cardiovascular end point associated with a 10-mm Hg higher systolic HBP were 1.28 (1.01-1.62) and 1.22 (1.00-1.49), respectively. At high-normal CBP and in mild hypertension, the HRs were 1.24 (1.03-1.49) and 1.20 (1.06-1.37), respectively, for all cardiovascular events and 1.33 (1.07-1.65) and 1.30 (1.09-1.56), respectively, for stroke. In severe hypertension, the HRs were not significant (p≥0.20). Among people with optimal, normal, and high-normal CBP, 67 (5.0%), 187 (18.4%), and 315 (30.3%), respectively, had masked hypertension (HBP≥130 mm Hg systolic or ≥85 mm Hg diastolic). Compared to true optimal CBP, masked hypertension was associated with a 2.3-fold (1.5-3.5) higher cardiovascular risk. A limitation was few data from low- and middle-income countries.Conclusions:HBP substantially refines risk stratification at CBP levels assumed to carry no or only mildly increased risk, in particular in the presence of masked hypertension. Randomized trials could help determine the best use of CBP vs. HBP in guiding BP management. Our study identified a novel indication for HBP, which, in view of its low cost and the increased availability of electronic communication, might be globally applicable, even in remote areas or in low-resource settings.Please see later in the article for the Editors' Summary.

UR - http://www.scopus.com/inward/record.url?scp=84893754765&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893754765&partnerID=8YFLogxK

U2 - 10.1371/journal.pmed.1001591

DO - 10.1371/journal.pmed.1001591

M3 - Article

C2 - 24465187

AN - SCOPUS:84893754765

VL - 11

JO - PLoS Medicine

JF - PLoS Medicine

SN - 1549-1277

IS - 1

M1 - e1001591

ER -