The predictive power of home blood pressure (BP) in the evening compared with home BP in the morning and office BP has been controversial. The predictive power of evening BP was compared to that of morning BP and office BP. The likelihood ratio test between one model containing a single BP index with traditional risk factors and a similar model further containing another BP index was used to assess whether the additional BP index significantly improved the adequacy of the model. Of 3266 patients with mild-to-moderate hypertension who were on antihypertensive medications (men 50.6%, age 59.5 ± 10.0 years), 58 experienced a major adverse cardiovascular event during a median follow-up of 7.1 years. The hazard ratios for a one standard deviation increment of evening home systolic/diastolic BP were 1.26 (0.98–1.62)/1.43 (1.09–1.88) in the baseline untreated period and 1.46 (1.17–1.81)/1.63 (1.26–2.11) during the on-treatment follow-up period. When evening BP at baseline and that during follow-up were included in the same model, only the latter significantly improved the prediction models (P = 0.006/0.005 for systolic/diastolic BP). Then, evening home BP vs. morning BP during follow-up was tested. The former did not improve the prediction models (P > 0.2), but the latter significantly improved the models (P ≤ 0.048). Similarly, when evening home BP and office BP during follow-up were analyzed, only the former significantly improved the prediction models (P ≤ 0.015). In conclusion, evening BP could be a more potent predictor than office BP, but it was inferior compared to morning BP in the treatment of mild-to-moderate hypertensive patients.
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The authors are grateful to all the HOMED-BP study collaborators as listed previously  for their valuable contributions. The authors would also like to thank the staff of Tohoku University and Teikyo University for their valuable help and Fujitsu Systems East Limited (Tokyo, Japan) and Omron Healthcare Co., Ltd (Kyoto, Japan), who developed and maintained the internet-based infrastructure for the measurement of blood pressure at home and the management of patients.
This study was funded by grants from the Japan Cardiovascular Research Foundation, the Japan Arteriosclerosis Prevention Fund, and Tohoku University. This study was also supported by Grants-in-Aid for Scientific Research (16K15359, 17H04126, and 18K06759) from the Ministry of Education, Culture, Sports, Science and Technology, and ACRO Incubation Grants of Teikyo University. No funding agencies had any role in the design or conduct of the study, in the collection, analysis, or interpretation of the data, or in the preparation, review, or approval of the manuscript.
Conflict of interest
KA, YI, and TO were concurrent directors of the Tohoku Institute for Management of Blood Pressure, which was supported by Omron Healthcare Co., Ltd. The remaining authors have no disclosures to report.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The original online version of this article was revised: In the sentence beginning ‘A total of 252 patients’ in this article, the term ‘office BP at baseline’, and the number of patients ‘n = 7’ and ‘n = 5’ should have read ‘office BP at follow-up’, ‘n = 5’, and ‘ n = 7’, respectively.
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Uchida, S., Kikuya, M., Asayama, K. et al. Predictive power of home blood pressure in the evening compared with home blood pressure in the morning and office blood pressure before treatment and in the on-treatment follow-up period: a post hoc analysis of the HOMED-BP study. Hypertens Res 45, 722–729 (2022). https://doi.org/10.1038/s41440-022-00860-0
- Antihypertensive drug treatment
- Blood pressure control
- Self-measured home blood pressure
- Prospective study